1. Text 1 End Text 1 Learning Module 2: Psychological Needs of Older Adults Following A Disaster/Emergency

2. PREPARE Module 2 Slide 2 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

3. PREPARE Module 2 Slide 3 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.

4. PREPARE Module 2 Slide 4 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.

5. PREPARE Module 2 Slide 5 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

6. PREPARE Module 2 Slide 6 Depression Symptoms: 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)

7. PREPARE Module 2 Slide 7 Treatment of Depression 1. Early identification 2. Early treatment 3. Treatment with medications 4. Therapy

8. PREPARE Module 2 Slide 8 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

9. PREPARE Module 2 Slide 9 Anxiety Disorders 55 yrs. and older: 11.4% Under-diagnosed PTSD (post traumatic stress disorder) Depression 50% after Katrina

10. PREPARE Module 2 Slide 10 Treatment of Anxiety Pharmacotherapy for Anxiety Disorders Psychotherapy and Anxiety Disorders Cognitive-Behavior Therapy (CBT) Biofeedback Relaxation Therapy Physical Exercise Programs

11. PREPARE Module 2 Slide 11 Post-Traumatic Stress Disorder (PTSD) Anxiety disorder Develops after terrifying event or ordeal 3.6% of adults 30% of military veterans

12. PREPARE Module 2 Slide 12 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

13. PREPARE Module 2 Slide 13 Assessment of PTSD Tools to assess PTSD: –Clinician-Administered PTSD Scale (CAPS) –Primary Care PTSD Screen Recognize symptoms Make assessments

14. PREPARE Module 2 Slide 14 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.

15. PREPARE Module 2 Slide 15 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

16. PREPARE Module 2 Slide 16 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

17. PREPARE Module 2 Slide 17 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

18. PREPARE Module 2 Slide 18 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

19. PREPARE Module 2 Slide 19 Community-Based Services Outpatient psychotherapy Hospital day treatment programs Crisis services and counseling Case management Home-based services “Wraparound” Services

20. PREPARE Module 2 Slide 20 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

21. PREPARE Module 2 Slide 21 Resources Available to Older Adults The Red Cross Disaster Recovery Centers Disaster Advocates Eldercare Locator Families Outreach Services

22. Text 1 End Text 1 End of Module 2 Slides