Geriatric Mental Health Disaster and Emergency Preparedness

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Chapter 18 Disaster Related Elder Mistreatment (DREM) 371 help overcome tragedy since the feeling of loss may remain for a long time. Therefore, during assessments it is important to offer practical suggestions. A good assessment, including observation by mental health specialists, could result in an intervention to reduce stress symptoms and promote postdisaster adjustment (Fulmer, Guadagno, Bitondo Dyer, & Connolly, 2004), especially after potential mistreatment. Addressing the basic needs of shelter and finding a safe haven that provides food and water, sanitation, privacy, and opportunities to sit quietly, relax, and sleep, at least briefly, improves the clinician-patient alliance and prevents mistreatment ( Portelli & Fulmer, 2006). It is essential that older persons be encouraged to avoid alcohol and other drugs since these substances interfere with healing (Polivka-West & Berman, 2008). Re-establishing old routines is a practical way to decrease tension; staying busy with work or hobbies can provide a distraction to occupy the mind. Seeking information, advice, and help from others such as family, clergy, and support workers provides support and eases the negative effects of painful memories. However, it must be remembered that although most people are honest and trustworthy, some unscrupulous individuals try to take advantage of victims in the aftermath of a disaster (Acierno, Ruggiero, Kilpatrick, Resnick, & Galea, 2006). DREM PREVENTION STRATEGIES AND MANAGEMENT Since Hurricane Katrina, a number of agencies have created guidelines for caring for older persons during disasters, although few have addressed the specifics of DREM. Baylor College of Medicine and the AMA (2006) created a set of recommendations for managing older disaster victims that include the following strategies: 1. Develop a tracking system for the elderly. 2. Provide separate shelters for the elderly. 3. Involve aging specialists in planning for care and training aid workers. 4. Involve local social services and community organizations. 5. Use a triage system to ensure that the most critical victims are cared for. 6. Establish a means for shelter personnel to remain in touch with central administration. 7. Provide protection from abuse and fraud.
372 Geriatric Mental Health Disaster and Emergency Preparedness 8. Plan for evacuation of residents of long-term-care facilities. 9. Prepare disaster plans and conduct readiness drills. While the authors do specifically mention that abuse and fraud are possibilities that need to be prevented, they do not provide specific recommendations. Similarly, research on elderly mistreatment has provided guidelines for identifying and treating abuse but not specifically with regard to disasters (BCM & AMA, 2006). HelpAge International (2006), an organization dedicated to caring and advocating for older persons, has developed guidelines that specifically address DREM that include these recommendations: 1. Be aware of the possibility of elder abuse and provide protection ( Aldrich & Benson, 2008). This applies not only to caregivers and aid workers but also to members of the community (Andresen, et al., 1997) who can help reduce the possibility of intimidation, exploitation, and theft of older persons. 2. Be knowledgeable about the power dynamic between men and women, especially in shelters, where a need to fi ll quotas may create a gender imbalance. The authors stress that the risk of sexual abuse of older women increases when shelters have mixed genders without the informed consent of women. 3. Avoid the presence of large cohorts of older people without families, either due to loss, abandonment, or isolation (Weinstein, Fletcher, & Stover, 2007 ). Steps should be taken to fi nd support for these people either through community organizations, foster families, or extended family via family-tracing services. 4. Be sure to account for the sociodemographic and cultural characteristics of older persons when dealing with situations of possible abuse (HelpAge International, 2006). Medical personnel have an important role to play in the early detection and identification of elder abuse (Geroff & Olshaker, 2006). In the case of DREM, due to the lack of disaster and older persons mistreatment research, medical practitioners follow the AMA’s (1992) guidelines, which urge early detection and proper assessment of older persons. The implementation of such a structured protocol to DREM, however well intentioned, could be costly and counterproductive in the absence of careful planning and training for first responders and health care workers. Therefore, appropriate intervention and planning measures are critical
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Geriatric Mental Health Disaster an
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Geriatric Mental Health Disaster an
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Dedicated to Flo Aaroe, who personi
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Contributors xi Foreword by Robert
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14 Geriatric Assessment for Differe
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xii Contributors Terry Fulmer, PhD,
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xiv Contributors Douglas M. Sanders
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Foreword With the increase in the n
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Preface The rage you feel does more
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Preface xxi and (3) influence the d
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Preface xxiii as key to the prepara
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Acknowledgments In connection with
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1 A Primer for Disaster and Emergen
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Chapter 1 A Primer for Disaster and
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2 Older Persons in Disasters and Em
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Chapter 2 Older Persons in Disaster
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NORMAL CHANGES WITH AGING ORGANS/SY
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Immune Function Laboratory Tests Em
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48 Geriatric Mental Health Disaster
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Table 3.3 GEC GEPR COLLABORATIVE PR
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Table 3.3 GEC GEPR COLLABORATIVE PR
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Community Response to the Needs of
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5 National and Cross-National Model
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Chapter 5 National and Cross-Nation
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6 Supervision and Facilitated Refl
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Chapter 6 Supervision and Facilitat
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INTERNATIONAL TREATIES Team Respons
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120 Geriatric Mental Health Disaste
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8 Self-Help Tools for Older Persons
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Chapter 8 Self-Help Tools for Older
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9 Volunteers: Who Are They and What
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Chapter 9 Volunteers 159 munity com
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Chapter 9 Volunteers 161 RECRUITING
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Chapter 9 Volunteers 163 et al.). O
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Chapter 9 Volunteers 165 cial effor
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Chapter 9 Volunteers 167 nizations
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VOLUNTEERS PROVIDING AND RECEIVING
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Chapter 9 Volunteers 171 Gibson, M.
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Clinical Response to the Needs of O
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Table 10.1 PRE-DISASTER/BASELINE DO
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Table 10.2 DURING-DISASTER SYMPTOM
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Table 10.3 POSTDISASTER SYMPTOM DOM
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Table 10.5 POSSIBLE BENEFITS OF SEL
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12 Complementary and Alternative Ap
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Chapter 12 Complementary and Altern
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Where to Find a Therapist Chapter 1
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Self-Care Chapter 12 Complementary
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13 The Interdisciplinary Treatment
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Chapter 13 The Interdisciplinary Tr
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Choose solutions Review literature
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14 This chapter focuses on the ment
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15 Bereavement and Grief: What Is N
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Chapter 15 Bereavement and Grief 29
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The Length of Mourning Chapter 15 B
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16 The Experience of Vulnerability
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Chapter 16 The Experience of Vulner
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Spirituality of African Americans/A
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