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 II (Projects aiming to enhance clinical safety and outcomes, clinical governance / risk management)
Authors (including presenting author) :
CHAN YK (1), CHAN TS (1), LI HY (1), WONG TT (1), CHENG HY (1), TSANG SM (1), CHENG KW (1), HO SKS (1), KNG PLC (1), PANG HSI (1), LAM HY (2), TAO KYC (2), YUEN PY (2), KWONG SF (2)
Affiliation :
(1)Department of Medicine and Geriatrics, RTSKH, (2)Physiotherapy Department, RTSKH
Introduction :
Sarcopenia have emerged as an important syndrome in geriatrics. Luk and Chan (2022) pointed out that the prevalence of sarcopenia is reported to be 9% among in-patients aged ≥65 years; and Fhon et al. (2023) stated that sarcopenia is highly common among people with falls, ranging from 6.1 to 26.6%. Sarcopenia is associated with many poor outcomes in older adults. Early detection helps to predict and facilitates better judgement for appropriate management and resource allocation. Therefore, care bundles of fall and sarcopenia is introduced to Acute Care for Elderly (ACE) units to prevent the patient’s loss of independence from admission to discharge.
Objectives :
1) To enhance the detection of sarcopenia among elderly with falls at in-patients setting; 2) To improve the care coordination by using the fall and sarcopenia care bundle in acute geriatric wards; 3) To enhance continuity of rehabilitation after discharge home
Methodology :
A nursing working group was formed in May 2023 to conduct literature review and develop program outline. A care bundle of Acute Fall and Sarcopenia Program including the workflow, assessment form, educational video and exercise training kit with nutrition supplementation were set up with multidisciplinary support. The care bundle was implemented at 2 acute geriatrics wards from 1 July to 30 September of 2023. All community dwelling patients who were diagnosed with fall, were recruited into this program. Ward nurses were trained to 1) perform sarcopenia assessments by using screening tools suggested from the literature; 2) to implement specified nursing interventions for patients during hospital stay; and 3) to provide phone follow-up with survey on day 14 and 3 months after discharge as evaluation.
Result & Outcome :
A care bundle of Acute Fall and Sarcopenia Program (AFS Program) is a practical means to enhance the early detection of sarcopenia in elderly and maintain good quality in fall nursing management. The significant positive outcomes corresponded with other fall prevention outcome measurements. The care bundle showed effect on lifestyle modification and enhancement of sarcopenia care plan regarding to better judgement for appropriate management. 18 patients (mean age 81.8) were recruited. All participants had completed the program and 61.1% are male patients. The mean length of stay was 6.95 days. 10 participants were diagnosed as possible sarcopenia by initial nursing assessment. Only 2 participants noted with fall episode within 3 months after discharge. Comparing the responses of participants to items regarding the fall episode before admission and after discharge show a statistically significant difference t(17) = 6.269, p <0.001. Besides, 2 participants were identified with visual problems and referred to eye clinic for follow-up; 3 participants had medication risk related with fall and advised on postural blood pressure monitoring and medications reviewed by doctor. Furthermore, a positive behavioral change was noted among the participants as their mean exercise training hour/week increased from 0.78 to 2.53 and mean outdoor activities hour/week increased from 3.64 to 4.06 after program.
