Authors (including presenting author) :
Wong MK(1), Cheung MC(1), So TWP(1) Dr. Wong OF(2)
Affiliation :
(1)Occupational Therapy Department, North Lantau Hospital (2)Department of Accident and Emergency, North Lantau Hospital
Introduction :
Frailty is a clinical syndrome common amongst older adults. It is associated with fall risk, disability, hospitalization and mortality. The multidisciplinary health care team of Emergency Medicine (EM) ward fully acknowledges the need for full spectrum intervention, and hence a pilot Geriatric Emergency Medicine (GEM) program was implemented in October 2019 to January 2020. Occupational Therapist (OT) as a core team member, offering expert opinions in identifying multi-dimensional risk factors contributed to frailty and to stratify an effective OT intervention in cater the specific needs of frail elderly patients.
Objectives :
Verify if the newly designed OT intervention model mitigates risks associated with frailty and evaluate the feasibility of related program logistics.
Methodology :
EM ward patients come from home and age more than 65 with a Clinical Frailty Scale (CFS) of 4-7, and fulfilling one of following criteria, i.e. fall, musculoskeletal condition, decreased general condition pre-existing medical problems, dizziness and caring problem recruited. Abbreviated Mental Test (AMT), HKMoCA-5, Modified Barthel Index (MBI), Lawton Instrumental Activities of Daily Living Scale (Lawton IADL), Fall Risk Assessment Tool (FRAT), Geriatric Depression Scale (GDS) were adopted as multi-dimensional assessments to identify high risk frail elderly. Personalized Occupational Therapy intervention was prescribed to address patient’s specific needs.
Result & Outcome :
A total of 34 patients were recruited with majority aged between 80-84. The top three principal diagnosis was dizziness (29%, N=10), fall (26%, N=9) and medical problems (17.6%, N=6). 18 patients (53%) had at least one fall episode within 6-month prior to admission. After OT’s intervention, patient’s mean MBI score increased from 74.2 to 79.4. (P value <0.05). Number of patients with AMT score less than 8 reduced from 53% (N=18) to 50% (N=17). The FRAT high risk group decreased from 79% (N=27) to 49% (N=16) (P value< 0.05). Most importantly, 29 patients (85%) continued living at home. Only 1 patient readmitted due to fall within 3 months after discharged. The newly designed OT intervention model serving well in optimizing rehabilitation outcome, facilitating safe discharge, empowering care giver and enabling safe community re-integration. In view of the benefits demonstrated, OT together with other multi-disciplinary team members drew the consensus to extend the trial period of this GEM program. Community OT home visit is also considered as an effective means for safe community re-integration and the triage mechanism is streamlined further for the extended trial period in 2021-22.
