Demented Patients Have Shown Impact Of Tragedy (Nov./Dec. 2001)

By Paula Hartman-Stein, Ph.D.

Frail elderly in long term care settings- even nonverbal, cognitively impaired patients-have tended to show serious increases in behavioral disturbances since the recent terrorist attacks of Sept.11..

 Patients with severe dementia may not understand that the planes crashed into the World Trade Center in New York only once after viewing the same televised scenes of the crumbling towers repeatedly, says Barbara Lohn, M.D., a geriatric psychiatrist in Ohio.  Highly demented patients in nursing homes often sit in front of a communal television for hours, and staff may not realize the potential negative behavioral effect of repeated visual images of war, she believes. At life’s other extreme, children may understand explanations of the terrorist events better than patients with Alzheimer’s  who are disoriented to time and place, Lohn explained.

         Jiska Cohen-Mansfield, Ph.D., Director of the Research Institute of the Hebrew Home of Greater Washington, pointed out that the increase in behavioral disturbance in nursing home residents can stem from tension, anxiety, and grief among those who surround them.

 To abate problems, Lohn recommended techniques such as reducing sensory stimulation, using calming music and softer lights as well as limiting exposure to news programs, especially before meals or bedtime. Support group meetings for nursing home staff who provide direct care services may indirectly decrease anxious behavior in their patients.

        Repeated images of bombings and war may rekindle feelings of terror that the older adult experienced firsthand in WWII or Korea. Greg Hinrichsen, Ph.D., geropsychologist at Hillside Hospital in New York, observed that persons with prior traumatic experiences, notably Holocaust survivors, are generally more distressed compared to other older adults in his practice.

 Anger and frustration were the predominant emotional reactions expressed in group therapy sessions with older veterans, according to Amber Gum, psychology intern at the Palo Alto Veteran’s Administration hospital. She reported that the group sessions revolved around ways of decreasing the intensity of anger and irritability by using strategies such as prayer, improving communication skills, and limiting the amount of time watching news reports or reading about terrorist events.

         Additional coping strategies generated by out-patient therapy groups for older adults in community settings include giving money or donating blood as well as connecting with old friends and distant family members, and decreasing isolation and loneliness.

 Hinrichsen, who has volunteered at New York City’s Family Assistance Center, has worked with older adults who lost children in the World Trade Center. He explained that they are not only dealing with their own grief but also the complicated interpersonal issues arising with in-laws of the deceased child.

         Perls and Silver in their book, Living to 100, summarized the remarkable ability of the “old-old” to handle severe stress. They emphasized how a centenarian Holocaust survivor did not become entrapped in anger, self-pity, or hatred toward the Nazi’s, but spent her energy on engineering the survival of her family. Many older adults who have coped well with past personal hardships and losses view the events of 9-11-01 as tragic, but they remain hopeful because of their past successes in handling loss and grief.

 Hartman-Stein, P.E. (2001) Demented patients have show impact of tragedy. The National Psychologist, Vol. 10, No. 6, p 12.