Psychological distress and somatic symptoms after natural disaster: differential vulnerability among older adults.

In a panel study, more than 200 older adults were interviewed before and after a severe flood in southeastern Kentucky in 1984. The issue in this study was whether older adult flood victims were differentially vulnerable to increases in psychological and physical symptoms on the basis of their age, sex, marital status, occupational status, education level, and preflood symptom levels. Flood exposure was related to increases in depressive, anxiety, and somatic symptoms at 18 months postflood. Within this older adult sample, men, those with lower occupational status, and persons aged 55-64 were at significantly greater risk for increases in psychological symptoms. Sociodemographic status did not moderate the impact of flood exposure on physical health. Implications for crisis-intervention services to older adult disaster victims are discussed.

Psychological symptoms in older adults following natural disaster: nature, timing, duration, and course.

Using a prospective design with five follow-up intervals, the study addressed questions regarding the timing of onset, duration, course, and nature of psychological reaction to natural disaster. As participants in a statewide panel study, more than 200 older adults were interviewed both before and after two distinct floods occurred in southeastern Kentucky in 1981 and 1984. Exposure to these incidents, which differed in overall intensity, was assessed at both the individual and community levels. Personal loss was associated with short-term increases in negative affect, limited to one year postflood. Longer-term effects were more dependent on the level of community destruction. Exposure to high levels of community destruction was related to decreased positive affect up to two years postdisaster, whereas exposure to high levels of both community destruction and personal loss was predictive of increased negative affect for two years.

Effects of bereavement/loss and pre-event status on subsequent physical health in older adults.

Males and females aged fifty-five and older were interviewed before and after three types of bereavement/loss: attachment bereavement (child, spouse, parent), nonattachment bereavement (sibling, grandchild, close friend), and other losses (nonbereavements). Five measures of health were used. Before pre-event health was accounted for on self-report measures of health status and medical conditions, pre-event measures of environmental factors and impact measures of bereavement/loss events had significant but modest effects on post-event health. However, after pre-event health was taken into account, the effects of bereavement and other losses were pale in comparison. Bereavement/loss events were not related to subsequent deaths, health events, or the use of medical services. Environmental factors were modestly predictive of nonattachment bereavements and other losses. An unexpected finding was that other losses had stronger effects on health than bereavements. Trend analysis over eighteen months showed a modest decline in health status immediately after a loss event, followed by an improvement in health. In general, this older adult sample handled bereavements and other losses with minimal morbidity and mortality.

Carry-over of medical information system influence to control patients.

Evaluations of medical information systems (MIS) often compare one or more dependent variables between experimental patients having the MIS available and control patients. Typically, physicians who are exposed to and therefore are potentially influenced by the MIS during visits with experimental patients also see control patients, thus possibly weakening the internal validity of subsequent comparisons between the MIS and the control conditions. The present study examines the possible bias due to carry-over of MIS influence to control patients in the context of a prospective, randomized design.