Authors (including presenting author) :
Chan CC(1), Lam SL(1), Li SK(1), Wong YK(1), Lai KW(1), Leung HC(1), Yip LF(1), Chiang KH (1)
Affiliation :
(1) Physiotherapy Department, Shatin Hospital
Introduction :
A new model of multi-disciplinary fall prevention program was implemented in Geriatric Day Hospital (GDH) in Shatin Hospital since November 2020. In physiotherapy aspect, it involved physical training, education, tele-care and home program.
Objectives :
(1)To reduce number of falls and hospitalization due to fall in elderly clients
Methodology :
GDH patients with principal diagnosis of fall or > 1 fall episodes in past one year were recruited. Patients with fall due to medical reasons (e.g. loss of consciousness), Montreal Cognitive Assessment (MoCA) score < 2nd percentile, medically or mentally not fit for training were excluded. The program lasted for 12 weeks. It involved physical training including strengthening, balance, functional and gait training, education on fall prevention, home exercise program and tele-care for assessment on functional mobility in home environment, exercise prescription and monitoring. Phone follow-up was conducted 3-month after GDH discharge. Outcomes concerning functional mobility and balance, including Modified Functional Ambulation Classification (MFAC), Berg Balance Scale (BBS), Modified Rivermead Mobility Index (MRMI), Timed Up and Go Test (TUG), 6 Minute Walk Test (6MWT), 30-second sit-stand test (30s CST) and Tinetti performance oriented mobility assessment (Tinetti), and fall-related outcomes, including Fall Efficacy Scale -Short (FES-short), number of falls and hospitalization due to fall in past one year and from GDH admission to 3-months post-discharge (about 6-8 months since GDH admission) were analyzed. Wilcoxon signed-rank test was used to analyze the difference before and after program.
Result & Outcome :
From November 2020 to December 2021, 31 patients completed the program. Upon the completion of program, patients demonstrated a significant improvement in balance (BBS: 29.2 to 36.4, p<0.001; Tinetti-balance score: 9.6 to 11.6, p=0.01) walking speed (TUG: 46.1 to 37.9, p=0.01), tolerance (6MWT: 124.6 to 172.9, p<0.001) and functional performance (MRMI: 27.4 to 30.9, p<0.001; Tinetti-total score: 16.3 to 21.5, p<0.001; MFAC: 4.7 to 5.23, p=0.03) while strength barely reached statistical significance (30s CST: 3.5 to 5.1, p=0.06). There was also a significant reduction in fear of fall (FES-short score: 16.1 to 14.0, p=0.01). At 6-8 months since GDH admission, the number of fall (p<0.001) and hospitalization due to fall (p<0.001) were significantly lower when compared to 1-year before admission. The new model of fall prevention program in GDH can improve functional outcomes and reduce number of fall and hospitalization due to fall. However, to evaluate the effectiveness of the program more accurately, fall outcomes should be evaluated 1-year after GDH admission in the future.
