SAN ANTONIO – When an earthquake or other natural disaster strikes, adult day health centers can play a critical role in feeding, housing, and relocating elderly members of the community with more serious health needs, reported administrators of a center who developed an impromptu disaster-management plan in the immediate aftermath of a 2010 earthquake.
After a 7.2 Richter magnitude quake in Baja California, Mexico, on Easter Sunday 2010, the staff of the Alegria Adult Day Healthcare Center (ADHC) in nearby Calexico, Calif., took on the task of helping displaced residents from an adjacent assisted living facility that had been irreparably damaged by the tremors, according to Dr. Bernardo Ng of the department of psychiatry at the University of California, San Diego, and medical director of the Alegria ADHC.
The staffers contacted primary care physicians to discuss medical needs, arranged access to clothing, meals, transportation, and nursing services for suddenly homeless seniors, and helped prevent exacerbations or new onset of mental illness, they reported in a poster presentation at the annual meeting of the American Association for Geriatric Psychiatry.
"An ADHC that has the expertise of dealing with older adults on a daily basis should play a principal role in this kind of disaster plan. A key factor to be successful in whatever you want to carry out is that you partner with agencies or entities involved with whatever resources are available in the community," Dr. Ng said in an interview.
He acknowledged that, as a day facility, his center did not have a specific plan in place to act as a surrogate for the assisted living facility. As a result, he and his colleagues had to make it up as they went along.
The condemned building, a former hotel that had served as an assisted living facility since 1999, housed 98 seniors who had to be evacuated overnight, when building inspectors condemned it as unsound after the quake. The residents were relocated to local hotels but had no access to their clothes, medications, or personal belongings.
On the 3rd through 5th days after the seismic rift, the day center staff provided the residents with meals and transportation, and contacted their primary care physicians to discuss immediate needs. Many of the primary care offices and local pharmacies were damaged in the quake and remained closed for several days after the event.
In addition to providing the seniors with their own clothing and helping them with hygiene such as showering and shaving, the staff performed blood pressure and glycemia checks, provided physical therapy and regular activities, conducted tuberculosis screening and cognitive screening, and contacted family members.
Thirty days after the event, patients were reported to be more anxious, but none required hospitalization. No changes were required in psychotherapy or in medications, and no new onset mental illnesses were reported. The percentage of assisted living residents who attended the day center rose from 15% before the quake to 25% afterward. Some of the other displaced seniors went to stay with families out of town or friends, and those who were able to live more independently relocated to senior apartments, primarily outside the city.
"Disaster management after an earthquake is especially challenging, since there is little warning, an inability to predict potential scale of impairment of mental health services, and a loss of broad infrastructure," the authors wrote.
They noted that their sample was relatively small, but with appropriate support and monitoring, such plans could help to minimize the negative mental health consequences of disasters in larger communities.