Geriatric Mental Health Disaster and Emergency Preparedness

Chapter 2 Older Persons in Disasters and Emergencies 41
these hormones produce widespread and sometimes extreme physiologic
changes in body organs and function. In persons with certain diseases
these changes may be harmful instead of helpful. Examples of the physiologic
processes and potential harmful effects in diseases common in older
persons are shown in Table 2.3. Other complex stress response processes
increase blood coagulation, perhaps especially in older persons, which may
increase the chance of acute obstruction of coronary arteries leading to
myocardial infarction ( Wirtz, et al., 2008).
In addition to this acute response, the brain under stress stimulates
the release of another adrenal gland hormone that works more slowly. Acting
through the hypothalamus, stress causes the release of corticotropin
( ACTH ) from the pituitary gland into the bloodstream. ACTH stimulates
the release of cortisol from the adrenal glands. Cortisol, normally present
in relatively low amounts, has diffuse bodily effects. With increases
over a short time span it generally is protective of the organism, reducing
excess inflammation and bolstering the physiologic systems that aid survival.
But over weeks to months, elevated cortisol may produce significant
problems. Indeed, chronically very high levels of cortisol, caused
either by the intake of oral cortisol-like drugs or by tumors, results in a
disease called Cushing’s syndrome, which dramatically shortens life if
untreated. Some of the adverse effects of excess cortisol include the following:
elevated blood sugar, reduction of muscle mass, thinning of the
skin, increased central body fat, thinning of the bones, water retention,
and elevated blood pressure (McEwen, 1998). Perhaps the most significant
adverse effect for older persons is a reduced ability to fight infections,
to which they already are more susceptible for multiple reasons.
Cortisol also affects the brain and can lead to confusion, sleep disturbance,
and depression ( Varghese & Brown, 2001). The connection between abnormalities
of cortisol and cortisol regulation and depression is strong
( Barden, 2004).
Physical Effects of Emotions / Mental Disease
Established emotional problems may produce behavioral and physical
changes with substantial consequences in disaster situations. Depression
blunts a person’s ability to respond to situations in an energetic manner
and, thus, may put the person at increased risk. It also may lessen appetite
and nutritional intake with resultant physical weakening. In the frail older
person particularly, undernutrition may result in a reduced ability to fight