Geriatric Mental Health Disaster and Emergency Preparedness

34 Geriatric Mental Health Disaster and Emergency Preparedness
Because of their relative health and experience, persons in the 65- to
75-year-old age group have the potential to be of tremendous assistance
in crises. Persons between 75 and 85 who are in good health also may be
of help in ways that do not require many physical demands. These healthy
older persons should be considered a resource in disasters, able to help
others both physically and emotionally. Even frail older persons usually
have preserved cognitive capacity and can contribute. Of course, persons
of any age who focus on doing something to contribute to the well-being
of others tend to cope better in a disaster.
Physical Changes With Aging
and Resultant Weaknesses
The key consideration for older persons in disasters is their physical frailty.
If there are threats to the body, the decreased resistance and resilience of
older bodies means they may require more support from others to prevent
distress or death. In medicine, this relates mainly to the physiologic
ability to maintain bodily processes, including brain activities, in the face
of disease, injury, environmental stressors, or other causes of potential
physiologic disequilibrium.
The normal aging process that results in frailty for virtually everyone
over age 85 includes changes in every body system. Table 2.1 shows the
major changes and their implications regarding health and disease. Persons
caring for older persons in disasters will need to consider these changes
when designing programs to improve outcomes for the most vulnerable.
Most significant problems of older persons are caused by disease, not by
normal aging. If there is loss of function, assume there is underlying disease
that potentially can be treated .
In addition to the normal changes of aging, of course, older persons
have more disease processes. Particularly common and problematic diseases
include atherosclerotic heart disease, congestive heart failure, chronic
lung disease, diabetes mellitus, and chronic kidney disease. This chapter,
of course, cannot discuss the details of managing these diseases, but key
needs that may be helpful to consider when planning for caring for older
persons during disasters are expressed in Table 2.2. Medical management
and preparation for disasters need to be arranged with trained personnel.
Medications and Risk in Disasters
No discussion of the care of older persons, especially frail older persons,
can omit medications. Certain medical problems, particularly reduced