Geriatric Mental Health Disaster and Emergency Preparedness

42 Geriatric Mental Health Disaster and Emergency Preparedness
infections and will generally weaken all the body ’ s functions. Specific nutrient
deficiencies will also affect other diseases, especially those of the
heart and brain. Depression also affects the sensation of pain and is a
major factor in chronic pain syndromes, both producing and aggravating
them. As noted earlier, the pituitary-adrenal connection and response is
affected by depression and may be a factor in reducing resistance to infection
in chronically depressed individuals.
Anxiety frequently accompanies depression, but it is also extremely
common by itself. The brain often responds to anxious feelings by setting
off the fight-or-flight reaction, although sometimes at a lower intensity.
In acute situations, anxiety may precipitate the physical problems caused
by the release of adrenal hormones as noted earlier. Panic attacks, part of
the spectrum of anxiety disorders, may result in multiple physical symptoms,
including heart palpitations, chest pain, shortness of breath, dizziness,
numbness of the extremities, and even muscle spasms affecting the
hands. They are very distressing and may initially be difficult to differentiate
from life-threatening problems such as myocardial infarction or
pulmonary embolus, especially in older people, who are more prone to
these severe problems.
Psychotic disorders, particularly paranoia, may cause people to avoid
others, including the support system that may be necessary for their survival.
The acute worsening of schizophrenia induced by disaster stresses
may produce a complete inability to attend to personal physical needs,
particularly shelter and food.
Emotional Effects of Physical Experiences
Being in a disaster situation, perhaps seeing significant loss or injury of
family and friends and possibly suffering personal physical harm, produces
major emotional responses. Immediate losses or threats of loss and
physical distress produce anxiety and sadness, which may be severe. Persons
with underlying psychiatric illness have a much greater chance of
relapsing into uncontrolled psychiatric states precipitated by these stressors.
Those with past trauma, especially PTSD, may suffer flashbacks or
more severe reactions to their current situation. Longer duration stress
may cause depression in anyone, perhaps in part because of the cortisol
excess noted earlier; those already prone to the disease succumb sooner
or more severely. There is the potential for early interventions to reduce
the severity of acute and chronic emotional problems caused by disasters