Geriatric Mental Health Disaster and Emergency Preparedness

Immune
Function
Laboratory
Tests
Emotional
Function
Chapter 2 Older Persons in Disasters and Emergencies 37
Decrease in white cell function,
but not in numbers.
Various “barrier defenses” decreased,
particularly in lung
and urinary tract.
Most are not different. Postprandial
blood sugar rises;
erythrocyte sedimentation rate
(ESR) rises; possible slight
decrease in hemoglobin/hematocrit
(debated).
Not signifi cantly changed. If
anything, elders are more able
to withstand problems that
cause emotional reactions.
Increased risk of infections.
Often exacerbated
by malnutrition, which also
reduces immunity.
Generally not clinically
signifi cant. If a lab test is
abnormal, look for a cause
other than aging. (However,
don’t worry about an ESR
less than 50 mm/hr.)
If an elderly person has
an emotional symptom
(particularly depression),
don’t consider it a normal,
“understandable” fi nding.
Evaluate and treat it!
renal function, are much more common as people age, and these problems
often require low doses of medication to avoid complications. Other diseases,
such as congestive heart failure, coronary artery disease, diabetes
mellitus, chronic lung disease, and hypertension, also are more common
and create medication dependency.
The frequency and severity of adverse reactions to medications tend
to be greater in older people. Kidney function is predictably reduced as
people age. Any drug or active drug metabolite that is cleared by the kidney
should be prescribed in a lower dose in persons over age 85 or in
younger older persons with hypertension and /or diabetes mellitus, which
also worsen kidney function. Using normal doses may result in excess
drug accumulation and adverse effects. The old adage of start low, go
slow — which pertains to initial dose and dose increases — is useful for
these types of drugs.
Probably the main reason older persons are at much greater risk of
adverse drug reactions is the fact that they take more medications. Any
added medicine has not only its own risks, but also the risks of interactions
with drugs already taken. New medicines, including and perhaps
especially psychotropic medications, should be given only after careful
consideration. Because medical providers want to help people, we sometimes
turn to medications when the need for them is questionable in the
hope they might help. A helpful adage when considering whether or not