Geriatric Mental Health Disaster and Emergency Preparedness

32 Geriatric Mental Health Disaster and Emergency Preparedness
FUNCTION AND FRAILTY
The concept of function 3 is central to understanding the care of the older
person. The word function , as used in gerontology , means the ability to
do the things needed to maintain one’s body and household in adequate
condition. This definition focuses mostly on physical and cognitive abilities,
rather than on the occupational, social, and psychological concept
of function used in the discipline of psychiatry and in the DSM-IV . But the
maintenance of function requires physical, cognitive, and emotional capacities
to perform the required activities.
Function is divided into two main categories: activities of daily living
(ADLs) and instrumental activities of daily living (IADLs). ADLs are the
simple activities required to maintain one’s body in a condition acceptable
in social situations — bathing, dressing, toileting, mobility (usually walking ),
maintaining continence of urine and stool (or controlling external manifestations
of incontinence), and feeding oneself (Katz, Downs, Cash, &
Grotz, 1970).
IADLs are activities requiring a higher level of cognition and emotional
function that are needed to maintain one’ s living situation. These include
managing finances, shopping, preparing meals, cleaning, managing
transportation, keeping a schedule, using a telephone, self-administering
medications, and similar endeavors ( Lawton & Brody, 1969).
Frailty is much more relevant than age in disaster situations. The concept
of frailty refers to more than just weakness or physical fragility. It
broadly encompasses the inability of the individual to maintain function in
the face of significant challenges — infection, injury, environmental changes,
nutritional deficiency, and so forth —to normal equilibrium (Campbell &
Buchner, 1996). Disease can make one frail at any age, and complications
of medical problems such as heart disease, diabetes, and chronic lung disease
become increasingly common as people age. By age 85, the normal
and unrelenting effects of aging have reduced virtually everyone to the
point of frailty even without any major disease.
The body and mind constantly respond to external and internal events
and conditions that may put the individual at risk. Some of these include
environmental issues such as high or low ambient temperature, a slippery
floor, or poor air quality; internal situations such as infections, metabolic
disturbances, and disease processes; and emotional factors, such as anxiety,
depression, and others. Each of us has an innate capacity to deal with
these stressors, a capacity that may be overwhelmed if an event is powerful
enough. As individuals age, their physical capacity to overcome these