Authors (including presenting author) :
Chan YLV(1), Poon KMM(1), Leung TCT(1), Lou LKK(1), Keung MYG(1), Chow CMS(1), Leung WKA(1), Mak HKC(2), Man KL(2), Leung SM(2), Chang MY(2), Luk KYH(1), Chan CMA(1)
Affiliation :
(1) Physiotherapy Department, Queen Elizabeth Hospital, Hong Kong (2) Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong
Introduction :
29% of community dwelling elderly in Hong Kong sustained at least 1 episode of fall and the risk for recurrent fall was about 24% to 40%. More than 800 patients aged ≥ 65 were admitted to the Department of Neurosurgery (NS) of the Queen Elizabeth Hospital (QEH) annually due to fall, causing significant morbidities and mortalities, inducing heavy burden on both the family and the health-care system. To minimize the recurrence of fall in these patients, the “Extended Care Program” was piloted in the Department of NS of QEH since August 2021. Physiotherapists worked collaboratively with doctors, nurses, Occupational therapists and social workers to identify, stratify the fall risk of the targeted clienteles and provide early support upon their discharge. The early Physiotherapy (PT) support included fall related education to patient and care-givers, outreach home modification and rehabilitation service and outpatient PT as indicated. Besides, Physiotherapists would also closely liaise with nursing coordinator to refer appropriate social support service for the clienteles in need.
Objectives :
To support safe community integration for the neurosurgical patients through multidisciplinary approach. To prevent recurrent fall and improve balance for these clienteles in the community.
Methodology :
Patients aged ≥ 65 who sustained fall with minor head injury would be screened by nurses in the neurosurgical wards. These patients would be further assessed by Physiotherapists to identify fall risk level and determine their fitness for discharge using Berg Balance Scale (BBS), Timed Up-and-Go Test (TUG), Modified Functional Ambulation Classification (MFAC) and Falls Risk for Older People-Community setting (FROP-COM). Outreach service would be provided for patients directly discharged home with high fall risk and caregiver education or outpatient physiotherapy services would be provided for those with low fall risk. During PT outreach service, home-based exercises, fall risk modification, caregiver education and educational pamphlets would be provided. Zoom meeting between patients and nurse would be arranged for medication management and consultation. BBS, TUG, MFAC, FROP-COM would be used for outcome evaluation.
Result & Outcome :
26 patients completed the outreach program (Age 80.9 ± 8.4). Both balance ability and functional walking speed showed statistically significant improvement. BBS improved from (36.6 ± 12.3) to (42.3 ± 10.6) (p<0.001). TUG improved from (45.2s ± 37.6s) to (28s ± 19.8s) (p<0.001). FROP-COM score significantly improved from (18.7 ± 6.9) to (15.6 ± 6.4) (p<0.001). 27% patients progressed from high to moderate fall risk and 15% progressed from moderate to mild. Only 2 patients (7.7%) sustained recurrent fall in 6 months after discharge. Physiotherapy home support program could enhance balance ability and minimize fall risk. Multi-disciplinary collaboration is the key to provide safe community integration for elderly clientele with fall risk.
