Asian Journal of Dietetics, 2024

Original
Impact of Utility Damage on Meals for Older Adults after
the Kumamoto Earthquake, Japan
Hiroka Sato1, Noriko Sudo2,*
1

Department of Food and Nutritional Science, Division of Life Sciences, Graduate School of
Humanities and Sciences, Ochanomizu University, Tokyo, Japan
2
Natural Science Division, Faculty of Core Research, Ochanomizu University, Tokyo, Japan
ABSTRACT In the post-disaster period, providing food especially for older adults is importantsince they require dietary care despite being in a lifeline disruption. In this study, we examinedfood service relating to utility disruption and explored the hardship of meals provision in older
adult-care facilities after a disaster. Out of 96 facilities which answered our first questionnaire
survey, we targeted 43 older adult-care facilities that were affected by the 2016 Kumamoto
Earthquake. We analyzed the records of six facilities from our second survey which reported
the changes in meals provision due to the earthquake. One facility without water, gas, andelectricity supply served only two meals per day mostly consisting of ready-to-eat foods. On
the contrary, facilities with lifeline supply could serve regular meals with just a few changes
in dishes. Food delivery was disrupted during emergency. A hospital lost contact with dealers
and could not get foods due to loss of communication tools. The number of staff was fewer
than usual, which resulted in increased pressure sore patients. Utility outage and difficulties ofdelivery or manpower led to skipping meals and were an obstacle to serve meals. This study
would contribute to preparation of meal provision in older adult-care facilities.
Keywords: disaster management; older adults; lifeline; meal provision, Kumamoto
Earthquake

INTRODUCTION
Japan is a disaster-prone country and has
experienced countless earthquakes, typhoons, andother disasters (1). The 2016 Kumamoto Earthquake,a recent large-scale disaster, damaged 198,000 homes
and disrupted electricity, gas, and water supply
infrastructure (2).
Lifeline outages after disasters are serious issues.
For instance, Ulak et al. demonstrated that areas withmany older adult residents were more susceptible toblackout in Hurricane Hermine occurred in 2016 (3).
Puerto Rico faced long-term power outage due toHurricane Maria in 2017 (4). In 2018 Hokkaido
Eastern Iburi Earthquake, elevator outages had anegative impact on residents in high-rise building (5).
Under these circumstances, providing adequate
food and nutrition is necessary in every phase of thedisaster, particularly for older adult (6). The shortageof foods in proper form and manpower to take care ofthem during disasters links to aspiration orundernutrition of individuals requiring special meal
attention (7). In fact, older adults complained that the
food at evacuation centers after 2016 Kumamoto
Earthquake was uncooked and hard to swallow (8).
After the 1999 Athens earthquake, nutritional intake
among older adults was insufficient (9). The residentsof older adult-care facilities depend on their facilities
for most of their life support, so facilities need tocontinue operations even during emergencies.Despite these facts, the meals provided in older
adult-care facilities following disasters remain
understudied. It is unclear as to what is served and how

staff change meal contents during emergencies.
Moreover, the relationship between available utilities
and meals which can be prepared under thoseconditions has not been verified. Therefore, this study
examines the relationship between utility disruption
and food service in the immediate aftermath ofearthquake and explores the actual situation of meal
provision in older adult-care facilities.
MATERIALS AND METHODS
Study setting and design
Kumamoto Prefecture is located in Southern partof Japan. In November 2020, the authors conducted
the first questionnaire survey on disaster preparedness
for food service to all older adult-care facilities inKumamoto, comprising 125 welfare facilities for theelderly requiring long-term care, 92 health carefacilities for the elderly requiring long-term care, 50
sanatorium type medical care facilities for the elderly
requiring care, and 6 integrated facilities for medical
and long-term care (10). Out of 96 facilities which
responded to the survey (response rate = 35.2%) (10),
we targeted 43 facilities affected by the 2016
Kumamoto Earthquake. The second questionnaire wasmailed in August 2021 to the food service managersof those facilities. Although some facilities presented
meal contents of several weeks, we focused on only 1–
3 days after the main shock that occurred at 1:25 a.m.
JST on April 16, 2016, during the acute phase of thedisaster (11).
Data sources and data collection methods
In the second survey, we inquired about (1) the
number of meals per day in normal times, and thefollowing for each meal occasion immediately after
the Kumamoto Earthquake: (2) type of tableware*To whom correspondence should be addressed:
sudo.noriko@ocha.ac.jp

1

Impact of utility damage on meals for older adults(daily use or disposable), (3) manpower, (4) whether
or not providing meals to non-residents, and (5) tostaff.
We also asked (6) whether meal contents werechanged due to the disaster, and if so, what changes
were made, (7) the state of utilities; water, gas,
electricity, and food delivery, (8) the frequency ofregular and disaster meals, and (9) the overall
impression about the disaster by free-text description.
Disaster meals are alternative menus for emergency,
which mainly consist of ready-to-eat foods.

extracted some free responses to describe thechallenges in emergency meal provisions in detail.
Ethical considerations
The following was explained in writing: thatparticipation in the questionnaire survey is voluntaryand even if they do not answer, they would not bedisadvantaged at all, that the respondent’s name andcontact information are used only for inquiries
regarding their answers, that responses would beanonymized and used only for research. By receiving
the completed questionnaire, we obtained the consent.
The Ochanomizu University Humanities and Social
Science Research Ethics Review Board (approval
number 2021-56) granted ethical approval for thisstudy.

Data analysis methods
Fifteen facilities responded to the second survey(response rate = 34.9%); among them, six facilities
reported the changes in meals due to the earthquake.
We thoroughly analyzed daily meal descriptions. The
location of each facility was available on the websiteof the Ministry of Health, Labour and Welfare (12),and the damage sustained was drawn from the websiteof the Cabinet Office (13). According to that
information, the seismic intensity of those six facilities
was above the upper range of 6. Data from the firstsurvey was used in determining the presence orabsence of a private generator, as well as the numberof electrical outlets from the generator in the kitchen(10). Supplements 1–3 show the contents of menus
categorized into food groups based on the Japanese
Food Guide Spinning Top (grain-based dish;vegetable-based dish; fish, eggs, and meat dish; milk;
fruits; and others) (14). In this manuscript, we only
summarized the changes in meal contents for threedays after the main shock and examined therelationship with lifeline usage. In addition, we

RESULTS
Faculty attributes
Table 1 lists the attributes of the six facilities.
Welfare facilities for the elderly requiring long-termcare and health care facilities for the elderly requiringlong-term care were represented as “Home”.
Sanatorium type medical care facilities for the elderly
requiring care were described as “Hospital”. Almost
all facilities, with the exception of Hospital F, hadprivate generators. However, only the kitchens ofHome C and Hospital D had outlets connected to
private generators. The tableware used in Homes A–C
and Hospitals D and E were disposable. Most facilities
had reduced the number of staff compared to usual.
Homes A–C distributed meals to non-residents aswell. Most facilities, except for Hospital D, prepared
meals for staff.

Table 1 Characteristics of six elder-care facilities (Days 1–3)
Home A
Home B
Home C
Facility type*abb

Hospital DcHospital EcHospital F
c

121
187
149

118
120
118

38
55
38

25
25
25

Yes

Yes

Yes

No

5

1

0

Not applicable

Disposable

Disposable
Day 1: Fewer
Days 2, 3: Same

Disposable

Unknown

Same

Same

Number of meals per day in normal times
52
120• Breakfast
76
170• Lunch52
120• Dinner
Possession of private
Yes
Yes
generator
Outlets in the kitchen
connected to the00private generator
Tableware
Disposable Disposable
Number of staff
Fewer
Fewer
(compared to usual)

Fewer

Providing meals to
Yes
Yes
Yes
No
No
No
non-residents**
Providing meals to
Yes
Yes
No
Yes
Yes
Yes
staff
* a: welfare facility for the elderly requiring long-term careb: health care facility for the elderly requiring long-term carec: sanatorium type medical care facility for the elderly requiring care** Neighbourhood residents who have evacuated to the facility, older adults at-home care, and older adults
living in other facilities, etc.

2Asian Journal of Dietetics, 2024

Relationship between lifeline utilities and meal
contents
Tables 2–4 summarize the status of lifeline
utilities and use of disaster meals for three days after
the earthquake (Days 1–3). Although Home B
described the meal contents on Day 1 only, otherfacilities provided descriptions of three days. On
Day 1, gas was fully available as usual only in HomeA (Table 2). That facility could serve three regularmeals, omitting one vegetable-based dish for supper.
Home B could not utilize most of the lifelines,
leading it to serve only instant rice with canned or
packaged foods as disaster meals. Hospital Dchanged the meal contents for lunch in response to
the disaster and used in-stock items for supper.
Hospital F had a disruption of water, gas, andelectricity compelling staff to use perishable foodsfrom refrigerator and freezer as priority. They served
only two disaster meals in a day, such as instant rice.
On Day 2, Home A, where only water was notavailable in perfect condition, could prepare three
regular meals omitting some dishes in each meal
(Table 3). Home C still had water outage. Staff
utilized food aid and foods that were close to their
expiry dates. That facility served only disaster meals
as alternative. Hospital D did not serve miso soup
due to elevator outage as it was too difficult to carryusing the stairs. Hospital E, which had water and gas
disruption, provided disaster foods such as canned
miso mackerel stew. Water, gas, and electricity in
Hospital F had still not recovered. The staff only
provided two disaster meals. On Day 3, neither water
nor gas was recovered in Hospitals E and F (Table4). Hospitals C, E, and F, where some lifeline
outages occurred, served disaster meals at least oncein a day. These three facilities utilized relief supply.

Hospital F still provided only two disaster meals in a
day.
Water
Table 5 shows the detailed usage status of
lifeline during emergency. Home B failed to makeuse of food aid due to water outage. That facility
covered the normal plate with plastic wrap to deal
with the water shortage. Hospital D could purify
cloudy water. The staff in that facility also indicatedthe necessity of having disposable dishes to prevent
infectious diseases. Those dishes were also reported
as a more convenient resource than a large water tankin Hospital F.
GasHome A was offered an electric rice cooker by
a local resident (Table 5). Portable stoves (Hospitals
E and F) and propane gas (Hospital F) were utilized
to provide meals and sterilize water by boiling.
Hospital E, where there was no outlet in the kitchen(Table 1), cooked and served meals in the staff
cafeteria (Table 5).
Electricity
As shown in Table 5, outage of steam
convection oven required alteration of meals.
Electricity outage forced staff to use foods stocked
in refrigerator and freezer. An elevator outage in
Hospital E forced staff to carry meals by bucket
brigade method.
Food delivery
Food delivery did not recover in Hospital D
even on Day 3 (Table 4). As the staff could notconnect with dealers, they experienced hardship in
procuring foods (Table 5). Hospital E did notindicate supply disruption (Tables 2–4); however,staff could not procure fresh vegetables in the usual
way. In Home A and Hospital E, special foods forolder adults were delivered.

Table 2 Status of utilities and meal frequency on the first day after the earthquake (Day 1)
Frequency of
Food
Facilities Water Gas Electricity
Changes made (free description)
RegularDisasterdelivery
meals
meals
l Supper: One vegetable-based
A
○
○
○
3
0
△
dish was omitted.
○
l All meals: Instant rice was served
B××
except for×
03
with canned or packaged food.
morning○
C××
except for
0
3
Not specified△
morningl Breakfast: Staff just provided
what they had available at thattime.
○ except○lLunch: Meal content wasD○forexcept for×
2
1changed according to themorning morning
situation.
l Supper: Food in stock were used.
E○cloudy

×

○

○

1

3

2

Not specified

Impact of utility damage on meals for older adults

F

×

×

×

○

0

2

l All meals: Food from refrigerator
and freezer were used as priority.
Instant rice was served.

○: available, △: partly available, ×: not available
Table 3 Status of utilities and meal frequency on the second day after the earthquake (Day 2)
Frequency of
Food
Facilities Water Gas Electricity
Changes made (free description)
RegularDisasterdeliverymeals mealsl Breakfast: The content of vegetable-baseddish was changed according to the situation.
A
○
○
○
3
0
l Lunch: Bread could not be provided.
△l Supper: One vegetable-based dish wasomitted.
l Breakfast: Rice was cooked on gas (notusing instant rice as previous day)
C
×
○
○
0
3
l Lunch: Food aids were served.
△
l Supper: Sauté was prepared using nearexpired food.
l Breakfast: Miso soup was not served whenthe elevators were not working due to○difficulty in carrying it on the stairs.
D
○
○
×
3
0
cloudyl Lunch/Supper: Stocked food was used toprepare regular meals.
l Breakfast: Disaster food, canned miso
mackerel stew was used.
E
×
×
○
○
2
1
l Snack: Instead of lunch, a snack wasserved.
l All meals: Food from refrigerator and
F
×
×
×
○
0
2
freezer were used as priority. Instant rice
was served.
○: available, △: partly available, ×: not available

Table 4 Status of utilities and meal frequency on the third day after the earthquake (Day 3)
Frequency of
Food
Facilities Water
Gas
Electricity
Changes made (free description)
RegularDisasterdeliverymeals mealsl Breakfast: One vegetable-based dishwas omitted.
○l Lunch: One vegetable-based dish was
A
○
○
3
0
△ except foromitted.
morningl Supper: One vegetable-based dish andclear soup were omitted.
l Supper: Milk and strawberries wereadded. Strawberries were provided by
C
×
○
○
2
1
△
a local farmer.
l Breakfast: The president provided
large amount of food from areas withminimal damage. Staff went shopping○in a nearby prefecture to overcome
D
○
○
×
3
0
cloudyfood shortage.
l Lunch: Meals were provided using
what they had in the facility (including
relief supply).
l Lunch/snack: Instead of lunch, snack
was served.
E
×
×
○
○
2
1
l Supper: “Protein jelly,” a relief food,
was provided.

4

Asian Journal of Dietetics, 2024

F

×

×

○

○

0

2

l All meals: Meals were prepared using
food aids.

○: available, △: partly available, ×: not available

Table 5 The lifeline situations of each nursing care facilityl B: Although we received food aid, the vegetables could not be washed due to the lack ofwater. The length of the water outage was unknown, so we decided to cover normal plateswith plastic wrap for several days after the disaster.
l D: As the water was cloudy, we used a water purifier and used purified water in cooking. On
Water
Day 5, norovirus-infected individuals entered our facility, infecting other residents. There
was insufficient disposable tableware from that day.
l F: The family of a staff member brought a large water tank to wash dishes. However,disposable ones were more convenient.
l A: An electric rice-cooker was provided by a local resident.
l E: Staff used some portable stoves in the cafeteria and provided hot meals.
Gasl F: We could serve meals and boil water to disinfect using portable stoves and propane gas
thanks to lifeline providers.
l E: The cooking methods were changed for the regular meals due to the outage of the steam
convection oven. All staff served meals by bucket brigade method because the elevator had
stopped due to an aftershock.
Electricityl F: On Days 1 and 2, food in refrigerator and freezer were used as priority. Because of theelevator outage, we carried cooked meals manually to a hospital ward and served them.
l A: Dealers provided us with food thickeners and some food.
l D: Despite calling contractors, they had no explanation for delivery failures. We worked hardto procure food.
Food delivery
l E: Fresh vegetables were difficult to get for a few days. We could get eternal feedingproducts and special food for vulnerable as usual.
A, B, and D–F refer to different facilities (Table 1).
We only chose comments describing difficulties and coping methods which would contribute to disaster
preparedness for the future.
ManpowerSome staff from Home A and Hospital D wereforced to stay in the gymnasium or their cars overnight(Table 6). Under these situations, volunteers or staff
from other facilities helped their works. Due to thelack of available care in Home B, the number ofresidents with bedsores increased.
Food
Local residents and farmers donated foods toHomes A and C. Hospital D reported that it was hard
to serve milk or fruit. Hospital F had difficulty inutilizing food aid because of the close to expiry dateand high-sodium content food (Table 6).
Nutrition
Home A, which was damaged the least of all six
facilities (Tables 2–4) provided meals considering
nutrition as usual (Table 6). In Home B, staff worried
about nutrient deficiencies among residents due tofood shortage. Although Hospital D tried to provide
balanced and delicious diets, the nutrients appeared to
be deficient.

Table 6 Situations other than lifelines of each eldercare facilityl A: Some of the staff slept in the
gymnasium or in their cars.
Volunteers came to help out with
our work.
l B: Because staff could not provide
Manpower
enough care for older adults, there
were more patients with bedsores.
l D: Some staff had difficulty incommuting and camped in theircars. Staff in charge of morning

Food

5

shift were unable to commute, so
those working in other facilities
helped us serve meals.
l A: Food was provided by local
residents.
l C: Farmers near the facility
provided asparagus andstrawberries.
l D: Milk and fruit were difficult toserve after the disaster.
l F: Food aid, such as instant rice,
noodles, and canned food wereImpact of utility damage on meals for older adults
followed by foods preserved in a freezer (21). Food
service facilities always have large refrigerators andfreezers. If food there can be stored in good condition,
it would ease food shortage in emergencies. Therefore,
above everything else, limited electricity from inhouse generation should be connected to cold storage
equipment. Electricity is also necessary for the
purpose of using cooking appliances; if electric
appliances such as blenders cannot be used, it isdifficult to make appropriate meals for older adults(22). This could cause aspiration pneumonia, a lifethreatening illness (7). Although five out of six
facilities had private generators, only two of them hadoutlets in the kitchen which connected to an in-house
generator (Table 1). Because the provision of meals
will be hindered without refrigerators and cooking
equipment, portable generators should also be
arranged in advance.
Hospital D struggled with procuring foods due tounavailability of communication tools to connect withdealers (Table 5). Even in a facility that provided
meals without missing any, staff was concerned about
malnutrition among older adults (Table 6) as they aresusceptible to infection7. Some food aid they received
were close to expiry date or had high sodium content(Table 6), as seen in a previous study (23,24). That
meal contents were inadequate for older adults, as
hypertension is a concern (7). To deal with this,contact with the outside world is essential because
meal scores during the Great East Japan Earthquake
were related to that (25). Because email or landline
telephone cannot be used during power outage,facilities should create emergency contact lists (17) or
utilize social networking services such as LINE tocommunicate with dealers (26).
Although our respondents did not clearly refer totransportation, its impairment could also cause limitedaccess to foods (19). Special foods are especiallyvulnerable to stagnation or deterioration (27) due totheir production on a small scale. Thus, having foodstockpile, not relying on food aid, is essential to ensure
consistent provision of special care meals for older
adults.
Manpower
As observed in previous studies (28) somefacilities accommodated outside evacuees, although
they had fewer staff than usual (Table 1). The
manpower shortage might cause increased number ofpressure sore patients (Table 6). Moreover, meal
provision for the staff (Table 1) is also inevitablebecause staff tend to suffer from health issues due tooverwork under a chaotic situation (290. Because meal
preparation under those emergency situation isdifficult, human resource planning that utilizes
external support is a crucial part of business continuity
plan. For example, inter-networks among meal
provision facilities are structured within thejurisdiction of the Okayama Bihoku Health
Department. This network allows disaster-stricken
facilities to request meal delivery from places inregular operation (30).
Limitations of this study
The first limitation is the small number offacilities analyzed. Our final number of respondents
was only six facilities, which is very small since thetarget of the analysis was narrowed down to facilities
in which the disaster affected the content of meals andthat described the content of meals for one day ormore. The second limitation is that some of theirdescription about changes in meals content weredelivered. However, some of themwere near their expiry dates and/or
were high in sodium, which made itdifficult to use them.
l A: Nutritional considerations were
given to older adults as usual.
l B: Staff were concerned that
residents took lower amounts ofnutrition than usual due to foodNutritionshortage.
l D: We made all the efforts to servebalanced and delicious diet as muchas possible, but the nutrition seemed
to be insufficient.
A-C, and F refer to different facilities (see Table 1).
We only chose comments describing difficulties andcoping methods which would contribute to disaster
preparedness for the future.
DISCUSSION
Lifeline disruption made food provision difficult.
Hospital F, where water, gas, and electricity had been
cut off on Days 1 and 2, served only two meals perday. Meals in this facility were all disaster foods asalternative of regular menus. On the contrary, threemeals were served as usual in Home A, where only thewater supply was partially disrupted. That home
simply omitted a few dishes without any otherdifficulty. This result shows that meal provisions had
a definite link to utilities. Older adults in disasterstricken areas require special dietary care (70), so thedisruption of lifelines precludes appropriate foodsupply and the use of cooking appliances which
require gas and electricity.
Disposable dishes were used in most facilities(Table 1), which are convenient resources undersuspension of water supply. However, garbagedisposal facilities might stop working due to themalfunctioning of incinerator after the disasters (15).
The excess garbage accumulation in health carefacilities and hospitals for long period could lead tosanitary and health problems (16). This might
particularly affect older adults, who are susceptible toinfection7. Although disposable dishes might be user
friendly for staff (Table 5), they are usually thin andfragile making it difficult for older adults to eat (17).
Therefore, normal dishes covered with plastic wrap
(Table 5), might be preferable in terms of reducing thevolume of waste and improve usability for older adults
unless there is no virus-infected individual.
Ensuring heat source is also essential because it
affects cooking well-balanced diet (18). In fact,
Hospital F, the only facility without a private
generator, could not serve regular meals at all for threedays (Tables 1–4). This presents the necessity to havegenerators and find other places for cooking, such as acafeteria as seen in Table 5.
Electricity lead vulnerability in facilities during
emergency (19). This study also revealed that power
outages limited the range of available foods. As in thecase of Hospital D, which refrained from serving easyto-spill soup for safety (Table 3), meals may need to
be transported by hand on a stairway if elevators areunavailable. For that case, facilities should consider
using transportable containers to deal with theunavailability of meal carts (20).
Like Hospital F, where foodstuffs in the
refrigerator were used first (Table 5), it isrecommended to utilize perishable foods as priority,
6

Asian Journal of Dietetics, 2024

ambiguous. They provided free responses describing
meals changes. At times, it was unclear how
ingredients and cooking methods were changed.
Therefore, we could not strictly divide betweenchanged and unchanged meals. However, this is thefirst study to describe the precise meal contents served
at senior care facilities in an acute phase of a disaster.
We were able to clarify the actual situation of meals
provided during disasters and evaluate the direct
impact of utilities by taking a descriptive approachrather than statistical analysis.

8)

9)

10)

CONCLUSION
Utility outage leads to skipping meals andrepresents an obstacle to serving meals. On thecontrary, facilities with lifeline supply can serve
regular meals with a few changes in dishes. Moreover,food deliveries were disrupted by the earthquake. The
number of staff was fewer than usual in some facilities
resulting in increased pressure on staff and patients.
Human resource planning utilizing external support
thus appears to be crucial for business continuity.

11)
12)

ACKNOWLEDGMENTS
We would like to express our sincere gratitude to
everyone who participated in the questionnaire survey.
1)

2)

3)

4)

5)

6)

7)

13)

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medical institutions in Miyagi Prefecture
affected by the great East Japan earthquake. Ann
Rep Inst Living Environ Sci 44: 13–24. (inJapanese). 2012.
21) Bales CW, Tumosa N. Minimizing the impact ofcomplex emergencies on nutrition and geriatrichealth: planning for prevention is key. In:
Handbook of Clinical Nutrition and Aging(Bales CW, Ritchie CS, eds). p 635-654. 2009.
Humana Press, Totowa.
22) Harada M, Ishikawa-Takata K, TsuboyamaKasaoka N. Analysis of necessary support in the2011 Great East Japan Earthquake disaster area.
Int J Environ Res Public Health 17: 3475. 2020.
23) Ainehvand S, Raeissi P, Ravaghi H, Maleki M.
Natural disasters and challenges towardachieving food security response in Iran. J Educ
Health Promot 8: 51. 2019.
24) Nekouie Moghadam M, Amiresmaieli M,
Hassibi M, Doostan F, Khosravi S. Toward abetter nutritional aiding in disasters: relying on
lessons learned during the bam earthquake.
Prehosp Disaster Med 32: 382–386. 2017.
25) Nozue M, Ishikawa-Takata K, Sarukura N, Sako
K, Tsuboyama-Kasaoka N. Stockpiles and foodavailability in feeding facilities after the great
East Japan earthquake. Asia Pac J Clin Nutr 23:
321–330. 2014.

26) Sudo N, Urakawa M, Tsuboyama-Kasaoka N,
Yamada K, Shimoura Y, Yoshiike N. Local
governments’disasteremergency
communication and information collection for
nutrition assistance. Int J Environ Res Public
Health 16: 4617. 2019.
27) Ministry of Agriculture, Forestry and Fisheries.
Food stockpile guideline for vulnerable people.
https://www.maff.go.jp/j/zyukyu/foodstock/guidebook.html (in Japanese). Accessed August 16,
2023.
28) Peterson LJ, Dobbs D, June J, Dosa DM, Hyer
K. ‘You just forge ahead’: the continuingchallenges of disaster preparedness and response
in long-term care. Innov Aging 5: igab038. 2021.
29) Azuma T, Saito R, Ogawa Y, Hoshino E,
Nakamura E, Suzuki H. Effects on physicalhealth of the staff of local government byengaging in the work in the disaster—From thechange of examination for medical examination
data before and after the Mid-Niigata
Earthquake. Niigata J 124: 671–680. (inJapanese). 2010.
30) Okayama Prefecture. Internetwork among meal
provision facilities.https://www.pref.okayama.
jp/page/350264.html (in Japanese). Accessed
August 28, 2023.

8

Asian Journal of Dietetics, 2024

Supplement 1: Meal served on the first day after the earthquake (April 16, 2016: Day 1) Homes A-C
BreakfastGrain-based dish
Vegetable-based disheslllFish, eggs, and meat dishes

Home B

Regular meal
Rice
Vegetable dishes
Japanese pickles

Disaster meal
Instant rice

l
l

Lunch

l

-*
l

-

Milk
FruitsOthersHome A

Miso soup
Furikake†

Vegetable-based disheslllFish, eggs, and meat dishesl
Milk
FruitsOtherslSupperGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
Fruits
Other

l
l
l

Disaster meall Breadlcanned or poucheddishes-Regular meal
Grain-based dishHome C

Vegetable juice-lDisaster meal

Strawberry
pudding
Disaster meal

Rice
Root
vegetablesalad
Yuan-style grilledfish
Agedashi tofu
Clear soup
Regular meallInstant rice
-

l
l

Rice
Potato saladlCannedorpouched disheslMapo tofu‡

Rice
Spaghetti salad
Beef miso stewl-Disaster meallInstant rice
Cannedorpouched dishes-

Disaster meal
l
l
l

Rice
Kidney beans
Cannedmackerel-* not served† Furikake: Japanese seasoning sprinkled on the rice, which is made of some mixed ingredients such as sesame
seeds, dried fish flakes, seaweed, and so on‡ Mapo tofu: Stewed tofu and minced meats seasoned with red pepper, Sichuan peppercorns, doubanjiang (chilibean paste), fermented black beans, and so on (Chinese dish)9Impact of utility damage on meals for older adults
Supplement 2: Meal served on the first day after the earthquake (April 16, 2016: Day 1) Hospitals D-F
Hospital D
Disaster meal

BreakfastGrain-based dish
Vegetable-based dishes-

Fish, eggs, and meat dishes-

Milk
FruitsOthersl

Lunch
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk

l
l
l
l
l

Fruits

l
l

2
packs
of
Pempals†
Regular meal(changed)
Rice
Salad
with
vinegar and miso
Fish-ball stew
Soy milk tofu
Milk-

OthersllGrain-based dish
Vegetable-based dishesllFish, eggs, and meat dishes
Milk
Fruits
Other

Rice
Sweet
potatosalad
Japanese pickles
Grilled fish withplum sauce
Matcha agar

Rice balls
Crab-flavoredomeletMiso soup
Furikake‡-

Disaster meal

Disaster meal

Rice balls
Broccoli saladlStewed fish

l
l

Milk
Cannedtangerine
-

-

l
l

Hospital F-*llRegular meal(changed)

SupperHospital E
Disaster meal

-

l
l

l

Regular meallll

Rice balls
Egg-bound soup
with
wheat
glutenBeef and tofu
stew-

Instant rice
Vegetable sauté

Miso soupDisaster meallllInstant rice
Dressedsalad(carrots and green
beans)
StewedGanmodoki§ andvegetable soup-l
* not served† Pempal: Oral nutritional supplement produced by Nestle.
‡ Furikake: Japanese seasoning sprinkled on the rice, which is made of some mixed ingredients such as sesame
seeds, dried fish flakes, seaweed, and so on§ Ganmodoki: A fried tofu mixed with some sliced ingredients such as vegetables (Japanese dish).

10

Asian Journal of Dietetics, 2024

Supplement 3: Meal served on the second day after the earthquake (April 17, 2016: Day 2) Homes A, C
Home A
BreakfastGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthers

l
l
l

l

Lunch
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthersSupperlllGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
FruitslllOthersll

Regular meal
Rice
Japanese pickles
Fried tofu stew
Miso soup
Regular meal
Rice balls
Stewed vegetables
Cream stew
Regular meal
Rice
Sesame-dressed salad
Fish with tomato sauce
Miso soup
JellyHome C
l
l

l
l
l

l
l
l
l
l

Disaster meal
Rice
Dried daikon strips-*
Miso soup
Furikake†
Disaster meal
Bread
Strawberries
PotageDisaster meal
Rice
Sauté
Curry
-

* not served† Furikake: Japanese seasoning sprinkled on the rice, which is made of some mixed ingredients such as sesame
seeds, dried fish flakes, seaweed, and so on

11Impact of utility damage on meals for older adults
Supplement 4: Meal served on the second day after the earthquake (April 17, 2016: Day 2) Hospitals D-F
Hospital D
Regular meal(changed)

BreakfastGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes

l

Rice

l

Tofu stewl

FurikakelllRegular meal(changed)
Rice
Stewed hijiki‡Cream stew

Milk
FruitsOthersLunch
Grain-based dish
Vegetable-based dishes

Hospital E
Combination ofregular & disasterfoods
l Ricel Grated daikonl Misomackerelstew
l Miso soupl Furikake†

Hospital F-

Disaster meal-

Vegetable-based dishes

Fish, eggs, and meat dishes

l

l
l
l

Apple jelly-

Regular meal(changed)

Combination ofregular & disaster
foods

Rice
Vegetable omelet
Cauliflower salad

-

l

l
l

l

Stew with meatstuffed inari
Pork miso soupDisaster meall

Clear soup-

Others

-

l

Milk

l

Castella manju or
Isocal jellyHC ||Rice
StewedGanmodoki§
and vegetable
Miso soupDisaster meal

Rice balls
Steamed eggplant
Pickled cucumber-

Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
Fruitslllll
FruitsOthersSnack--

SupperGrain-based dish-lFish, eggs, and meat dishes
Milk
FruitsOthers-*Rice
Stir-friedsalmon flakes
and cabbage
Chinese-style
shrimp stew-

* not served† Furikake: Japanese seasoning sprinkled on the rice, which is made of some mixed ingredients such as sesame
seeds, dried fish flakes, seaweed, and so on‡ Hijiki: One of the seaweeds which is usually used in stewed dishes§ Ganmodoki: A fried tofu mixed with some sliced ingredients such as vegetables (Japanese dish)|| Isocal jelly HC: Oral nutritional supplement produced by Nestle

12Asian Journal of Dietetics, 2024

Supplement 5: Meal served on the third day after the earthquake (April 18, 2016: Day 3) Homes A, C
BreakfastGrain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthers

l
l
l

l

Lunch
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthersSupperHome A

Home C

Regular meal

Regular meal

Rice
Tsukudani*
Japanese pickles-‡
Miso soup

l
l
l

l

Regular meal
l
l
l

l

Rice
Sesame-dressed salad
Chicken stew
Clear souplllRegular meal

Grain-based dish l Rice
Vegetable-based dishes l Plum vinegar-dressed saladFish, eggs, and meat dishes l Boiled fish with grated radish
Milk
FruitsOthers* Tsukudani: Shellfishes boiled in soy sauce and sugar† Hijiki: One of the seaweeds which is usually used in stewed dishes‡ not served§ Soboro: Minced and cooked fishes or meats

13

Rice
Hijiki†Japanese pickles
Miso soupDisaster meal
Mixed rice
Canned saury
Stew
Regular meal

l
l
l
l
l

Rice
Dressed salad
Stir-fried soboro§
Milk
Strawberries-Impact of utility damage on meals for older adults
Supplement 6: Meal served on the third day after the earthquake (April 18, 2016: Day 3)
Hospitals D-F
Hospital D
Breakfast

Regular meal (changed)
Grain-based dish

Vegetable-based dishes
Fish, eggs, and meat dishes

l
l

Rice
Tsukudani†lSimmered pumpkin
and deep-fried tofu-

Milk
FruitsOthersLunch
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthersSupperll

Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsOthersSnack
Grain-based dish
Vegetable-based dishes
Fish, eggs, and meat dishes
Milk
FruitsHospital F-llDisaster meal
Rice
Vegetable sautélMiso soup

Regular meal (changed)
Ricel Vegetable saladl Stew with dried
daikon strips
Grilled fish
Tangerine jelly
Regular meal (changed)

Grain-based dishHospital E
Combination ofregular & disasterfoods
l Rice ballsl Saladwithgrated daikonl Teriyaki‡ fishstew
l Miso soupl

Rice
Dressed daikon
Yogurt-dressed
salad
Chicken and egg
stew
-

-

Combination ofregular & disaster
foodslWakame rice

Disaster meal
l
l

Rice
Salad

l

Simmeredmackerel in miso
-

l
l

l

Babaocai§
Egg soup
Protein jelly-

Disaster meal

-

-

-

-

l
l

Others-*l

Milk
Citrusmadeleine
Protein jelly-* not served† Tsukudani: Shellfishes boiled in soy sauce and sugar‡ Teriyaki: Fishes or meats grilled or boiled with soy sauce, mirin, and sugar§ Babaocai: Thickened stew made of various foods including meat, shellfishes, vegetables, eggs and so on(Chinese dish)14