Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 18 Disaster Related Elder Mistreatment (DREM) 367
est associated with depression. Living with others has been associated
with an increased probability of mistreatment (Elmore & Brown, 2007).
However, this may not be a direct causal relationship because living with
others is a contextual factor in which mistreatment is more likely to occur
(Ehrenreich & McQuaide, 2001). It may be possible to reduce the
risk of mistreatment by modifying other factors associated with living
with others (Pattillo, 2005; Pekovic, Seff, & Rothman, 2007) rather than
changing the living circumstances of the older person. Changes in living
arrangements are often difficult and disruptive for older persons
(Elmore & Brown).
PTSD is the most prevalent postdisaster psychiatric ailment and in
older persons may be an indicator of negligence or mistreatment. Clinicians
should be aware that PTSD can be seen in subjects directly exposed
to the disaster (Schinka, Brown, Borenstein, & Mortimer, 2007) as
well as in older persons for whom the disaster triggers memories of past
trauma (Cook, 2002; Cook, Arean, Schnurr, & Sheikh, 2001) that can lead
to disabling anxiety (Lantz & Buchalter, 2003).
Portelli and Fulmer (2006) described how debilitating depression
after mistreatment could be another serious sequelae after a disaster. Feelings
of depression may be even stronger if the older person feels isolated
or that no one understands him or her (Somasundaram & van de Put,
2006). The clinician should be aware of symptoms of depression (Rao,
2006), which may include (1) suicidal ideation, (2) isolation, (3) sudden
changes in weight, (4) insomnia, and (5) alcohol or drug abuse, including
prescription drugs (Cook, et al., 2001). As a consequence of the aging
process but also a side effect of mistreatment, older persons may experience
multiple losses; transfer trauma, for example, may result in serious
psychological ailments and sometimes even death. The psychological
task associated with adjusting to new surroundings and routines can lead
to aggravation ( Torgusen, Kosberg, & Lowenstein, 2004), depression,
increased irritability, and serious illness and can sometimes make frail
older persons more susceptible to mistreatment (Ridenour, Cummings,
Sinclair, & Bixler, 2007).
Older persons are not a homogenous group. Sociocultural and religious
factors play roles in determining the vulnerability and neglect of
the older population (Rosenkoetter, Covan, Bunting, Cobb, & Fugate-
Whitlock, 2007; Rosenkoetter, Covan, Cobb, Bunting, & Weinrich, 2007).
What might be acceptable to an 85 year-old person may not be suitable
for a person 65 years of age. Individualized care is necessary, and the diversity
of the older population must be kept in mind. Neglect is commonly