Geriatric Mental Health Disaster and Emergency Preparedness

370 Geriatric Mental Health Disaster and Emergency Preparedness
emergency assistance (Barratt, 2007). Identifying local cultural or community
supports helps maintain or reestablish normal activities such as
attending religious services.
Mental health screening for older persons (Elmore & Brown, 2007 )
has been shown to be critical since the most common psychosocial symptoms
distinguished in diagnosis and treatment in cases of disaster are
ASDs and acute and chronic PTSD. The main criteria /symptoms to look
for in an assessment, as described by the DSM-IV (American Psychiatric
Association, 2000) , should include the exposure to the traumatic event,
persistent re-experiencing of the event, avoidance of stimuli associated
with the trauma (Fujita, et al., 2008; Portelli & Fulmer, 2006), and reduced
responsiveness to the environment as well as increased arousal not
present before the trauma, including mistreatment events (Grady, 2006).
Symptoms must be present for at least 1 month and must have caused
significant impairment in social, occupational, and other areas of function
(Bolin & Klenow, 1983, 1988). Due to the fact that PTSD is often complicated
by underlying neurological and physical disorders, a differential
diagnosis could document depression, adjustment disorders, obsessivecompulsive
disorders, schizophrenia, anxiety, alcohol or substance abuse,
or any combination of these (Bonnie & Wallace, 2002). A full assessment
would include the examination of symptoms such as re-experiencing, emotional
numbing, autonomic arousal, and avoidance. The clinician’s main
role is to differentiate between normal and abnormal responses to the
disaster (Bonder & Wagner, 2001; Goldstein, 1996; Portelli & Fulmer),
provide the support and comfort needed, and effectively diagnose the
underlying stressors leading to the illness (Andresen, Rothenberg, &
Zimmer, 1997). At the same time, the clinician must identify high-risk
individuals and follow up with proper referral or treatment and care.
The International Society for Traumatic Stress Studies (ISTSS) explains
how some older persons are more vulnerable than others, especially
individuals with prior or other underlying traumatic events in life,
such as accidents, abuse, assault, combat, emargination, or chronic medial
illnesses (Portelli & Fulmer, 2006). With such clients, the clinician
needs to encourage discussion and provide constant orienting information
and assurances regarding the situation. The clinician needs to engage
with the older person and assist in building a support structure around
the patient while assessing the reliability of the family or client support
group. “ Victims are forever changed by the experience of disaster” (U.S.
Department of Justice, 2002, p. 456). Facing life with a new experience
in the background and trying to understand its meaning doesn’t always