WASHINGTON, Sept. 18--Senior citizens may feel particularly vulnerable and should not be neglected during this time of crisis, according to Gary J. Kennedy, MD, president-elect of the American Association for Geriatric Psychiatry and a psychiatrist at Montefiore Medical Center in Bronx, NY.

Dr. Kennedy says older Americans who are isolated, dependent, previously traumatized and have physical or mental disorders are at risk for suffering anxiety, depression and acute stress syndrome.

“Initial disbelief is followed by psychological numbing, then protest and rage, bargaining, grief and ultimately adjustments,” says Dr. Kennedy, who has practiced geriatric psychiatry for 19 years. “Any of these feelings can emerge at some distance from the event when circumstances of real or threatened loss evoke unpleasant memories.”

For some seniors Tuesday’s terrorist attacks may resurrect memories of past losses and they will want to relive their grief. They may have feelings of fear, sadness, and uncertainty and not realize it. Emotions may be expressed physically or by the loss of independence. Rage may be irrationally directed at loved ones or at caregivers. Fear and unwarranted suspicions may cause them to avoid contact, and abandon their social schedule by staying indoors in a false sense of protection.

Dr. Kennedy offers 12 suggestions for senior citizens, their family members and caregivers:

1. Anticipate problems and reach out before they emerge. Early intervention can prevent prolonged disability.

2. Communicate. Even a brief “How are you?” can provide a moment of personal reflection and mutual support.

3. No one should be forced to talk about their feelings. Not everyone will know how they feel or be able to express complicated emotions.

4. Realize that no one can carry on as usual, but that most seniors can return to their daily routines despite moments of rage or despair. Rapid reentry to disrupted roles and relations restores the person’s sense of belonging, esteem, and purpose.

5. Do not be surprised when physical manifestations of psychological distress emerge. Old habits once conquered may reappear. Preoccupation with physical discomfort or medical problems may take hold. Fear, suspicion, and self-doubt can prove paralyzing.

6. Take time out to grieve through rituals, public events and worship.

7. Limit time spent hearing and watching accounts of the tragedy in the news media.

8. Take time for leisure, exercise, play and lovemaking.

9. Visit an older American and go outside for a walk or for a meal.

10. Realize the holiday season is approaching when emotions are heightened.

11. Expect memories of the event to appear in the distant future, when you may least expect it.

12. Healing requires patience; it is not always comfortable and rarely complete without the nurturing actions of others.

In more serious cases, a stress reaction can become pathological when it leads to suicidal thoughts, aggressive acts, alcohol or sedatives abuse, failure to attend to serious health issues, ongoing weight loss, persistent sleep disturbance, social isolation, and failure to return to social responsibilities. The senior should visit a physician immediately.

Dr. Kennedy says that while some seniors may be crippled by events, others will rise to the occasion through chance acts of kindness and resilience.

“Senior citizens have lived through the great depression, WW II, the Holocaust, racism, Korea, Vietnam and the impeachments of two Presidents. They have survived adversity that almost none of their children would expect,” Dr. Kennedy concludes. “They have the time and the experience of prevailing despite overwhelming losses to help the rest of us attend to the work ahead. Grandparents have always had a unique role in the family. Now they can play a critical role in the recovery of the nation.”

For the names of geriatric psychiatrists in your area, visit www.aagponline.org and click on “Need a referral?” or call the American Association for Geriatric Psychiatry at 301-654-7850.

The American Association for Geriatric Psychiatry (www.aagponline.org) is a national association representing and serving its members and the field of geriatric psychiatry. It is dedicated to promoting the mental health and well being of older people and improving the care of those with late-life mental disorders. AAGP’s mission is to enhance the knowledge base and standard of practice in geriatric psychiatry through education and research and to advocate for meeting the mental health needs of older Americans.

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