Learning Module 2: Psychological Needs of Older Adults Following A

Disaster/Emergency

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Priority Considerations

• Physical or emotional frailty• Personal loss more devastating• Isolation and potential hopelessness• Triggered memories• Chronic health problems• Medication needs• Sensory, mobility, or cognitive impairment• Increased anxiety or confusion• Loss of support systems

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Phases of Disaster

• Warning and Threat Phase: When there is insufficient warning, evacuation may create anxiety for older adults

• Impact Phase: Reactions can include confusion and disbelief.

• Rescue/Heroic Phase: Shock or denial, shielding the person from intense emotions.

• Remedy/Honeymoon Phase: Share feelings of common purpose and mutual support.

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Phases of Disaster

• Inventory Phase: Survivors explore the extent of their losses. Older adults may be affected by the loss of property, treasured possessions, and means of mobility.

• Disillusionment Phase: Sets in within several months among older adults who feel they have not fared well with official attempts to help.

• Reconstruction or Recovery Phase: Survivors come to terms with the need to re-establish homes and life patterns. Older adults may regard these tasks as too difficult. Prolonged feelings can lead to depression.

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Typical Reactions to Disaster

• Anxiety and depression• Isolation•Reliving past traumas• Problems with sleep• Horror, panic, anger• Demoralization• Sensitivity to loud noises

• Irrational fears• Alcohol or drug use• Fear of infection• Paranoia• Guilt, anger, grief

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DepressionSymptoms:• Loss of interest in activities• Significant weight loss or gain• Sleep disturbances• Agitation• Fatigue• Feelings of worthlessness• Loss of concentration• Thoughts of death or suicide• Feelings of helplessness or hopelessness• Crying spells• Physical complaints (dentures hurt, body is sore,

stomach aches, headaches)

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Treatment of Depression

1. Early identification

2. Early treatment

3. Treatment with medications

4. Therapy

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Anxiety

Occurs from stress and vulnerabilities such as a terrorist attack or natural disaster.

Mental and emotional symptoms:– Unrealistic concerns about things and life– Inability to put things off, obsession

Physical symptoms:– Chest pain – Increased heart rate– Inability to sleep

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Anxiety Disorders

• 55 yrs. and older: 11.4%

• Under-diagnosed

• PTSD (post traumatic stress disorder)

• Depression 50% after Katrina

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Treatment of Anxiety

• Pharmacotherapy for Anxiety Disorders 

• Psychotherapy and Anxiety Disorders

• Cognitive-Behavior Therapy (CBT)

• Biofeedback

• Relaxation Therapy  

• Physical Exercise Programs

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Post-Traumatic Stress Disorder (PTSD)

• Anxiety disorder

• Develops after terrifying event or ordeal

• 3.6% of adults

• 30% of military veterans

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Symptoms of PTSD

1. Fear and anxiety

2. Re-experiencing – night mares, feeling as though the event was happening again.

3. Avoidance/numbing – avoid thoughts and feelings, difficulty with both pleasant and unpleasant feelings

4. Increased arousal – irritability, anger, difficulty concentrating, easily startled.

5. Grief and depression

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Assessment of PTSD

• Tools to assess PTSD:

– Clinician-Administered PTSD Scale (CAPS)

– Primary Care PTSD Screen

• Recognize symptoms

• Make assessments

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Treatment of PTSD • Cognitive-behavioral therapy (CBT) - Has 2

components. Cognitive component helps people change their thinking patterns about their fears. Behavioral component helps change their reactions to anxiety-provoking situations through controlled exposure to the source of fear.

• Exposure therapy

• Group treatment

• Pharmacotherapy (medication) - Anti-anxiety drugs are the preferred medication for most anxiety disorders.

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Challenges in Diagnosis

• Depression is sometimes believed to be a normal part of aging

• Physical health problems may make the diagnosis difficult

• Older adults may present with different symptoms of PTSD

• Older adults are less likely to report mental health problems

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Normal Stress Reactions to Trauma

Physical Reactions:• Faintness, dizziness• Hot or cold sensations in body• Tightness in throat, stomach, or chest• Nausea or vomiting, headache

Behavioral Reactions:

Sleep disorders, nightmares, jumpiness, crying, isolation or withdrawal

Emotional Reactions:Shock, disbelief, anxiety, fear, sadness, grief, helplessness, anger, irritability, mood swings

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Abnormal Stress Reactions to Trauma

Physical Reactions:Worsening of illness, sleep disorders, memory problems, somatization disorder (physical symptoms that can’t be explained)

Behavioral Reactions:Isolation, reluctance to leave home

Emotional Reactions:Depression, despair, apathy, confusion, disorientation, suspicion, agitation, anxiety

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Minimizing Transfer Trauma Strategies to minimize transfer trauma:

• Provide reassurance

• Familiar staff should accompany evacuees

• Provide orienting information

• Meet physical needs

• Ensure that essential resident information accompanies the resident

• Help residents reconnect with their families

• Use multiple assessment methods to diagnose physical or psychological problems

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Community-Based Services

• Outpatient psychotherapy

• Hospital day treatment programs

• Crisis services and counseling

• Case management

• Home-based services

• “Wraparound” Services

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Working with Older Adults in a Disaster

Strategies:

• Provide strong verbal reassurance

• Assist with recovery of possessions, arrange for companions

• Relocate in familiar surroundings or with friends

• Help re-establish familial and social contacts

• Assist in obtaining medical and financial help

• Re-establish medication schedules

• Provide transportation

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Resources Available to Older Adults

• The Red Cross

• Disaster Recovery Centers

• Disaster Advocates

• Eldercare Locator

• Families

• Outreach Services

End of Module 2 Slides