Elders

Traumatic Response, Depression, and Dementia in the Elderly

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Mental health is a serious concern for elderly persons.  In fact, some studies show that elderly people are at greater risk of mental disorders and their complications than are younger people:  

  • From 15 to 25 percent of elderly people in the United States suffer from significant symptoms of mental illness.
  • The highest suicide rate in America is among those aged 65 and older. In 1985, this age group represented 12 percent of the total U.S. population, but accounted for 20 percent of suicides nationwide. That means close to 6,000 older Americans kill themselves each year.
  • Worldwide, elderly people lead the World Health Organization's list of new cases of mental illness: 236 elderly people per 100,000 suffer from mental illness, compared to 93 per 100,000 for those aged 45 to 64, the next younger group.
  • Severe organic mental disorders afflict one million elderly people in this country and another two million suffer from moderate organic disorders.

Many elderly persons do not seek or receive appropriate treatment, out of embarrassment or isolation or lack of physical or financial access to mental health care.  Additionally, elderly people, their loved ones and friends, and often their own doctors fail to recognize the symptoms of treatable mental illness in older people. They blame them on "old age" or think nothing can be done to alleviate the problem. As a result only 4 percent of the patients in community mental health centers are elderly, and only two percent of the patients seen in mental health private practitioners' offices or hospitals are elderly.

Here are some quick facts on disaster-related mental health in the elderly. 

Pseudodementias 
Elderly people may become forgetful, disoriented, or confused because they have developed a quickly reversible condition that is totally unrelated to dementia such as Alzheimer’s Disease. For example, medication interactions or overdoses, poor diet and other physical or mental problems cause symptoms that mimic dementia. Depression (see below) often resembles dementia in that its victims withdraw, cannot concentrate, and appear confused. 

Causes of pseudementias such as malnutrition, medication or dietary changes, and stress are particularly relevant in a disaster, and any elderly person suddenly exhibiting mental changes should be diagnosed thoroughly for these influences rather than for a dementia-related disease process. 

Depression 

Depression, considered the most common mental disorder, afflicts up to five percent of people aged 65 and older.   This disease is characterized by a deep sense of sadness, lessened energy and motivation, loss of pleasure in usual activities, and changes in appetite and sleep patterns. 

Although trauma-related stress is a normal disaster response, elderly persons who exhibit the above symptoms for more than two weeks following a disaster should receive additional evaluation to make certain that they are not developing depression. 

Dementias 

Dementia, which is characterized by confusion, memory loss, and disorientation, is not an inevitable part of growing old. In fact, only 15 percent of older Americans suffer from this condition. Of that number, an estimated 60 percent suffer from Alzheimer's disease, a progressive mental deterioration for which no cause or cure has been found.  Detailed information on caring for persons with dementia in disasters is included elsewhere on this website.

Elderly persons can respond to and even grow from disaster experiences in many of the same ways as can younger persons.  Attention to these mental health considerations can be important in facilitating their disaster recovery

Some of this fact sheet is based on information found at this site(pdf)

Elderly Persons With Dementia and Disaster Response

If You Know a Disaster is About to Occur

  • Get yourself and the person with Alzheimer’s to a safe place. 
  • Alert others (friends, family, medical personnel) to the fact that you are changing locations, and give them your contact information. Contact them as regularly as you can as you move.
  • Be sure there are people other than the primary caregiver who have copies of the person with dementia’s medical history, medications and physician information. 
  • Purchase extra medications.

If Relocation is Necessary 

In an emergency, people with dementia and their caregivers may find themselves uprooted or displaced to alternative living arrangements. Extra care and attention must be made to ensure the health and safety of the people with dementia in such environments. The change of location, plus unfamiliar noises and activities, may cause them increased stress and confusion. And, certain behaviors of persons with

Alzheimer’s may confuse or alarm others.  Try to:

  • Be calm and supportive, letting the person with dementia “borrow” from your sense of stability and perspective
  • Remain flexible, patient and calm - a person with dementia will respond to the tone you set.
  • Restate and respond to the emotion being expressed by the person with dementia. Ask, “Are you feeling frightened?”  Sometimes physical contact, such as offering a hand or a hug, is helpful.
  • Not  leave the person with dementia alone. Don’t ask a stranger to watch the person.

Even within a difficult space such as a shelter, try to create a stable and calm environment through: 

  • Trying to spend extra time with the person to help him or her adjust to the new environment.
  • As much as possible, trying to maintain daily routines.
  • Using simple sentences and explanation, and diverting attention to new and familiar topics and activities as necessary.  For example, a caregiver might say, “I know you want to go home. For now, we need to stay here. Let’s see if we can get some lunch.”
  • As appropriate, inform people around you that the person has memory loss.
  • Limit news media exposure to the disaster.

Take care of your loved one and yourself

  • Ensure proper nutrition and hydration for both yourself and for the person with dementia.
  • Make it a priority to find a doctor and pharmacy.
  • Find a good listener – seek spiritual support.

Some of this information is based on the guidelines provided by FEMA at this site.