Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Authors (including presenting author) :
LUI BKP1, HO SKS1, CHAN TS1, CHAN HL1, TAO KYC2, LEE JYL2, WONG YY2, KWOK CY3, FUNG WI3, HO PK3, WONG MYA3, KWAN HY4, LAM SS1, CHAN LY1, LEE KN1, CHAN LW1, TONG PY1, WONG CW1, PANG HS1, KWONG SSF, KNG PLC1
Affiliation :
1Department of Medicine and Geriatrics, RTSKH; 2Department of Physiotherapy, RTSKH; 3Department of Occupational Therapist, RTSKH; 4Department of Pharmacy, RTSKH
Introduction :
Frail elderly with complex multi-morbidity is prone to geriatric syndromes such as polypharmacy, decline in functional performance due to deconditioning and sarcopenia. Consequently, leading to dependency, falls and depression. Relying solely on geriatric day hospitals and outpatient allied health clinics creates demand burdens. Moreover, selected elderly prefers not to travel to hospital. The “Home care bundled package” as a sustainable and elder-friendly option to improve health and wellbeing of frail elderly was introduced at the Geriatric Day Hospital (GDH), Integrated Care Discharge Support for High-Risk Elderly (ICDS) and the high-risk elderly nurse clinic (HREN) of RTSKH since May 2023. There are 4 one stop packages for sarcopenia and deconditioning, medication safety, fall prevention and mental wellness. These packages also complement telehealth and care paradigm shifts to a home versus hospital settings.
Objectives :
This study evaluates one stop ‘home care bundled package’ delivered through geriatric nurse to enable home-based elderly friendly care which may reduce reliance on hospital services
Methodology :
Each of the 4 packages consists of elder friendly health educational information, instructions and exercise equipment for fall prevention, upper limb exercise e.g., squeezers, resistance exercise using TheraBand, dietary and exercise for sarcopenia, medication boxes for medication safety, designed by the multidisciplinary team. Mental wellness follows a triage for depression and tiered care which includes medical-social collaboration. Referral by doctor is based on criteria such as living at home, Clinical Frailty Score 4-6, opt not for GDH rehab or had graduated from GDH; or have potential medication problems or depression or mood issues were selected at GDH, ICDS and Geriatric SOPD to be assessed face to face by geriatric nurse at bundled nurse clinic or GDH. Education and tools in package are provided. Telehealth follow up was conducted at GDH afterward. Evaluation using phone follow up was conducted in December 2023 after 6-month implementation of the program
Result & Outcome :
6-month data was collected from June to November 2023 for evaluation. A total of 52(13.1%) out of 396 patients were recruited with the exercise package provided, while the number of patients received package of sarcopenia /deconditioning, medication safety and fall prevention were 45, 10 and 15 respectively. 41 patients joined the evaluation as 11 failed to be contacted, within which 28(68.3%) had regular home exercised using the exercise package. All 18 GDH recruited case complied with the home exercise, whose exercise frequency ranged from daily to weekly, and 10 – 35 minutes each time. The 3 ICM patients performed 15 – 30 minutes exercise 2-3 times per week or once every 2 weeks. Only 8(40%) out of 20 patients from the nurse clinic complied with regular home exercise with most of them performed 10-15 each time. 13 patients were referred to “Joyage”, a community support project, due to depression and anxiety at the nurse clinic.
The novel initiative attributed better support to the frail elderly who are at risk of fall, sarcopenia, medication safety and mental illness. Despite compliance rate is not high, it was revealed that telehealth care could reinforce better outcomes as reinforcement of home-based exercise. Thus, for more sustainable development of the program telehealth can be introduced as a mandatory element.
