Authors (including presenting author) :
CHEUNG YN(1), LAU MT(2), WONG OF(2), PAK AM(1), UY CH(1), LAI KK(1), LING WY(3), LAU KK(1), LU Y(1), LEUNG YK(1), LEUNG YYC(1)(3)
Affiliation :
(1)Physiotherapy Department, North Lantau Hospital, (2)Accident & Emergency Department, North Lantau Hospital, (3)Physiotherapy Department, Princess Margaret Hospital
Introduction :
The percentage of elderly in Hong Kong has been increasing over the years. To address the needs of elderly, a new care model Geriatric Emergency Medicine (GEM) Program has been established since October 2019 in North Lantau Hospital (NLTH) to improve clinical outcomes and consolidate discharge plan in a multidisciplinary approach.
Objectives :
1. To enhance the geriatric care in EM ward by implementing a multi-disciplinary care plan to target groups of patients 2. To facilitate an early discharge or formulate discharge plan 3. To disseminate, adapt, and incorporate geriatric care into the emergency medicine model of care 4. To maximize the rehabilitation potential of recruited elderly
Methodology :
From October 2019 to January 2020 and September 2021 to December 2022(on-going), targeted clients with age >= 65 and admitted with any one of the follow principle diagnosis were recruited. 1. Falls 2. Musculoskeletal pain 3. Decreased general condition 4. Inpatient optimization of pre-existing medical problems (e.g. HT, DM and electrolytes disturbance.) 5. Dizziness 6. Caring issues The essential care team involves EM doctor, GEM nurses, allied health professionals including PT, OT and Dietitian. ST, MSW and Psychiatric team will be referred upon request. Patients with Clinical Frailty Scale (CFS) score of 4 to 7 will be recruited into the GEM program. Physiotherapists will perform targeted geriatric assessments including Modified Rivermead Mobility Index (MRMI), Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), Timed up and go test (TUGT), Berg’s Balance Scale (BBS) and Hand Grip Strength. Early discharge plan will be discussed in multidisciplinary meeting. Discharge plan includes: 1. Discharge home with/ without community support for example community physiotherapy service 2. Short course of rehabilitation in EM ward within 1 week 3. Consult extended care (EC) team for Day Rehabilitation Centre (DRC) referral after discharge 4. Consult EC team to take over for anticipated prolonged hospitalization 5. Old aged home (OAH) placement
Result & Outcome :
Total 77 patients were recruited with mean age 82 years old. 83 % were discharged with home care whereas 8% were discharged to OAH. The remaining 9% were referred to EC bed for further management. Among the 64 patients discharged home, 20% of them were referred to DRC for further training. 22 patients were indicated for a short course of mobility training within 1 week. Patients received physical training significantly improved with MRMI, EMS and BBS. The mean MRMI was increased from 26 to 29, with total score of 40, which was statistically significant (p< 0.05, paired t-test). The mean EMS was slightly improved from 10 to 12, with total score of 20, the result was statistically significant (p< 0.05, paired t-test). The mean BBS was improved from 27 to 30, with total score of 56, which was statistically significant (p< 0.05, paired t-test). The mean TUGT was improved from 36 seconds to 34 seconds but the result was not statistically significant. The median for pre and post MFAC for the training group was 5 which indicated most of our clients were supervised walker. The result of hand grip strength of clients in GEM program was compared with the same age group of community-dwelling elderly in Hong Kong. In age group 60-69, mean hand grip strength of male training group was 28 kg, which is comparable to the mean hand grip strength 29 kg of the same group in Hong Kong(P50). The mean strength among 70 to 79-year-olds was 22 kg in men (P25) and 13 kg in women(P25). The mean strength among 80 to 89-year-olds was 19 kg in men (P40) and 15 kg in women(P50). In conclusion, the GEM program was an integration of multiple clinical expertise. Physiotherapists in GEM program play an important role in maximizing the rehabilitation potential of the recruited elderly and their care curriculum.
