For those with dementia, the Barclay fire could pack the biggest emotional punch

Having your home go up in flames is hard on anyone, but John Bruza, a Penn Medicine geriatrician, said the residents of Barclay Friends that he worries most about after Thursday's overnight blaze are those who lived in the memory unit.

"Change is difficult for everyone regardless of age, but, for patients with cognitive impairment, a change in environment can be like a change on the Richter scale of 10," he said.

Patients in the middle stages of dementia can become disoriented when someone rearranges the furniture in their room, he said. They thrive on routine.

They may be more likely to fall in a new environment. Family members and staff may notice that they are agitated or less interested in eating.

Bruza warns family members to expect problems when patients with dementia move. "Things are going to get worse before they get better," he said. Patients in assisted living or skilled nursing may also have memory problems that affect their ability to adjust to new surroundings.

While extremes in temperature are hard on older people, Bruza said he did not think that relatively brief exposure to smoke and then the chilly night air would be likely to cause an increase in deaths in people who were not directly affected by the fire. He would expect to see an increase in anxiety and distress. "Even for those without cognitive impairment, it's the loss of their home."

Some older people, he said, bounce back well from distressing events. "Many older adults can be extremely resilient emotionally," he said.

Once people with dementia are moved to new facilities, he said, "there needs to be a fairly rapid introduction to routines and things that can be familiar." That, for example, would include making sure that someone who particularly likes music therapy gets it.

Generally, people with dementia are more likely to remember emotionally distressing information than everyday occurrences, but residents who were in the fire may not remember it happened. They are more likely to notice that they're in a new place with new routines, Bruza said.

It would help for family members to spend extra time with older relatives who've been displaced, reassuring them and introducing them to staff.  It's also good to keep reorienting people with dementia to their surroundings. Here's an example of what Bruza might say to a patient who's just waking up in a hospital room: "It's Friday. You're in the hospital here at Penn Presbyterian. You're very sick with pneumonia, but we're giving you antibiotics."