Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Clinical Safety and Quality Service I (Projects aiming to improve efficiency and effectiveness of care delivery to meet international standards)
Authors (including presenting author) :
Cheung MC(1), Cheng KW(1), So TWP(1)
Affiliation :
(1)Occupational Therapy Department, North Lantau Hospital
Introduction :
Geriatric Emergency Medicine (GEM) program has been provided to selected EM wards patients since 2019, which demonstrated vast benefits to frail elderly by optimizing their functional performance and facilitating safe discharge to own home. With the intention to provide earlier intervention to frail elderly in the community (before attending AED or hospital admission), a pilot program in collaboration with CHC has been commenced since September 2022.
Objectives :
To review the effectiveness of the pilot FEP.
Methodology :
Community dwelling elders who are under CHC care and referred to OT, fulfilling one of the inclusion criteria: 1/ with fall history; 2/ decline ADL/ IADL; or 3/ decline cognitive function within recent 6 months, were recruited in FEP. Patients undergone thorough multi-dimensional assessments focus on four aspects including cognitive & psychosocial, functional performance, fall risk and level of frailty. Patients’ specific needs were then stratified for various mode/ intensity of interventions after reviewing of assessment results.
Result & Outcome :
27 patients were recruited for FEP from September 2022 to March 2023 with mean aged 79. 12 patients were identified as vulnerable to moderately frail by using Edmonton Frailty Scale. 54% patient experienced fall within 6 months while 38% of patient indicated different level of cognitive impairment.
63% of patient were stratified as low fall risk or low frailty level, one-off fall prevention intervention was offered as an individual consultation session. For patient consider with potential benefit for functional and/or cognitive rehabilitation, a course of personalized out-patient treatment were provided aiming at optimizing patients’ functional abilities. Community OT service was also offered for patients who were identified with high fall risks that imposed by either unsafe home environment and/ or sub-optimal daily living performance.
The mean Abbreviated Mental Test (AMT) score of discharged patients improved from 8.3 to 8.4, while the mean Modified Barthel Index (MBI) increased from 94.8 to 95.1. The mean Person-Environment-Occupation (PEO) related risk decreased from 9.4 to 7.1, while the mean Morse Fall Scale (MFS) decreased from 45.6 to 41. 3 out of 7 patients who initially identified as “high fall risk” was found improved markedly with fall risk decreased to “low level” upon discharged.
The preliminary outcomes of this pilot FEP for frail elderly in community was in general very positive. More thorough analysis has to be conducted with larger sample size before we can conclude the specific benefits of various program modules as well as on the possible impact in the reduction of A&E visits and hospital admission.
