Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 2 Older Persons in Disasters and Emergencies 39
and coronary artery disease, may suffer severe and potentially fatal exacerbations
of their conditions without their medicines, for which there are
no readily available substitutes. The major psychiatric problems, particularly
anxiety disorders and schizophrenia, usually need continued medications
to prevent rapid relapse. Depression tends to relapse more slowly
without medications, but it also may become much worse if untreated for
days or weeks.
Short of stockpiling crucial medications, there appears to be little
possibility of preventing the consequences of the absence of medications.
However, sometimes older patients get better when some of their meds
are stopped, so some patients might get better if they couldn’t get their
usual meds! 4
Inevitability of Higher Losses Among Older Persons
Given the high level of medical support needed to sustain the lives of
many frail elders and their reduced capacity to withstand physical stresses
in general, in severe disaster situations it is inevitable there will be high
losses in this population. This has been demonstrated in extreme heat
situations, in which older persons die in disproportionate numbers (Vandentorren
& Empereur-Bissonnet, 2006).
Persons working in disaster relief must be prepared for this possibility,
and programs to assist in dealing with these losses should be available.
Although not frequently discussed, the potential of facing hard decisions
about who will receive scarce resources to support life and who will be
allowed to die because of not receiving them must be considered when
training leaders of disaster relief efforts. Our country’s recent weather
disaster, Hurricane Katrina, unfortunately created such a dilemma, and
the unfortunate results reflected the lack of training and guidance ( Fink,
2009).
OVERLAP OF THE PHYSICAL AND EMOTIONAL ISSUES
Interplay of Emotional Experiences (Past and
Present) and Physical Experience, Including
Neuro-Endocrine-Physiologic Connections
The connection between mental processes and the body has tremendous
implications in disasters. The obvious tie is between emotional responses
and actions influenced by fear, depression, and anger. But there also are