Authors (including presenting author) :
Tsang YM(1), Lam HY(1), Chan HL(1), Fung MYD(1), Lo YKJ(1), Kwong SFS(1), Siu TS(2), Po MYY(3), Kong HL(4), Kng PLC(4)
Affiliation :
(1) Physiotherapy Department, Ruttonjee and Tang Shiu Kin Hospitals
(2) Community Geriatric Assessment Team, Hong Kong East Cluster
(3) Community Health Services, Hong Kong East Cluster
(4) Department of Medicine and Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals
Introduction :
In 2021-22, COVID-19 pandemic widely impacted on RCHE residents resulting in deconditioning, mobility deterioration and falls leading to further hospitalization and tight hospital resources. Therefore, community based programs were important in alleviating the burden. In the conventional “referral-based” care pathway, physiotherapists assessed cases in RCHE only after referral by Community Geriatric Assessment Team (CGAT) nurses and doctors when mobility problems were pronounced or presented adversely with falls as staff may miss earlier decline in mobility level. A new “proactive mobility assessment’ care pathway was implemented in August 2021 for every new RCHE resident under Hong Kong East Cluster (HKEC) CGAT care with the following objectives.
Objectives :
1. To screen and address mobility problems before they arise
2. To evaluate the rehabilitation potential of new RCHE residents and provide or refer to community rehabilitation service if indicated
3. To provide RCHE staff education and carer support
Methodology :
New residents in RCHE under HKEC CGAT were recruited for physiotherapy assessments and interventions. The outcome measures included Modified Functional Ambulation Category (MFAC) rated by physiotherapist and RCHE staff; and the Elderly Mobility Scale (EMS).
Physiotherapists will prescribe suitable walking aids, refer indicated residents to different rehabilitation services (e.g Multi-disciplinary Outreaching Support Teams for the Elderly (MOSTE), Geriatric Day Hospital), provide education to RCHE staff and provide a course of rehabilitation for indicated RCHE residents. Patient’s carer was contacted via telephone for updating mobility and care advice.
Result & Outcome :
From August 2021 to October 2022, 85 RCHE residents in 26 RCHE were included in this study. On average, physiotherapy assessment was conducted around 40.36 days after admission to RCHE. Among the 85 residents, 41.18% attained a correct mobility level assessment using the MFAC by physiotherapist, with 14.12% and 27.06% of elders’ MFAC being overestimated and underestimated respectively by RCHE staff. 36.47% of them required proper walking aids prescription. Education to RCHE staff was conducted for 63.5% of the residents and collaboration with non-HA community based physiotherapists (MOSTE) as appropriate.
To mitigate the adverse effects of deconditioning and falls frequently complicating COVID-19 infection and isolation measures, this new proactive care pathway identified mobility problems earlier and fill up the aforementioned service gap. Besides, the medical social collaboration with our community partner (MOSTE) for the rehabilitation of indicated RCHE residents could help to relieve the tight hospital resources.
