Geriatric Mental Health Disaster and Emergency Preparedness

20 Geriatric Mental Health Disaster and Emergency Preparedness
Delirium
Short-term antipsychotic administration is a standard treatment strategy
in patients with delirium, particularly antipsychotic medications with low
anticholinergic properties such as haloperidol (Tune, 2002). Atypical antipsychotics
are useful in the management of delirium. In geriatric medical
practice, it is always better to minimize the number and dosage of medications,
especially those that are prone to cause delirium. When a patient develops
delirium, treating the underlying cause is of extreme importance.
If the patient exhibits the hypoactive form of delirium, he can be managed
safely using nursing intervention, such as avoiding excessive sensory stimulation,
providing orientation cues such as a calendar or clock, encouraging
family presence for reassurance, and other such strategies. Using physical
restraints should be limited to patients who are at serious risk of falling or
pulling IV lines or urinary catheters. Patients with the agitated form of delirium
may end up requiring pharmacological interventions. Antipsychotics
with low anticholinergic activity, like haloperidol or risperidone, are preferred.
If the delirium is caused by alcohol withdrawal, benzodiazepines
can reduce withdrawal severity, the incidence of delirium, and seizures
(Mayo-Smith, 1997)
Insomnia
Prevalence rates of insomnia in people aged 65 and older range between
12% and 40% (Morin, et al., 1999). Older adults primarily report difficulty
in maintaining sleep, and, while not all sleep changes are pathological in
later life (Bliwise, 1993; Morin & Gramling, 1989), severe sleep disturbances
may lead to depression and cognitive impairments (Ford & Kamerow,
1989). Night waking produces significant stresses for carers and is
a common cause for demands for institutional living arrangements (Pollak,
Perlick, Linsner, Wenston, & Hsieh, 1990). The sleep deprivation of
insomnia may result in excessive daytime sleepiness, fatigue, irritability,
impairment of concentration, and an increased risk of involvement in a
traffic accident. Insomniacs report lower quality of life scores than good
sleepers (Leger, Scheuermaier, Philip, Paillard, & Guilleminault, 2001), and
continued unresolved insomnia may be associated with significant psychiatric
morbidity, predominantly depression (Millman, Fogel, McNamara, &
Carlisle, 1989; Roth, 2001). Furthermore, sleep deprivation has been associated
with a reduced tolerance to pain (Johnson, 1969) and may reduce
immune function (Moldofsky, Lue, Davidson, & Gorezynski, 1989). Bring-