Develop a New Rehabilitation Approach to Dementia and Mild Cognitive Impairment (MCI) Clients in Psychogeriatric Ward

Abstract Description

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Authors (including presenting author) :

Lui SF(1),Ng TW(1),Kong WC(1),Yeung HF(1),Ng K(1),Chow CH(1),Choi TK(1),Chan CS(1),Fok HN(1),Kong SO(1),Wong TK(1),Tsui HM(1)

Affiliation :

(1)Department of Psychiatry, Pamela Youde Nethersole Eastern Hospital

Introduction :

Clients suffering from mild cognitive impairment and dementia tend to develop a prognosis of losing Activities of Daily Living (ADLs), Instrumental Activities of Daily Living (IADLs) and mobility function. According to Maslow’s Hierarchy of Needs ,a psychological theory that ranks human needs in the form of a pyramid. It considers human need to satisfy the basic needs first i.e. food, self- care skill, safety before striving for another growth needs such as self- esteem , self -actualization and transcendence .Yet, Hong Kong nowadays dementia therapies such as life review and reminiscence therapy which are likely focusing on the upper part of needs in the hierarchy i.e. satisfaction of self- actualization . In reality, MCI and dementia caused care givers need to look after clients with ADLs and IADLs such as grooming, dressing, feeding ,bathing .In view of maintaining ADLs , IADLs and mobility function for MCI and dementia clients, a new approach of rehabilitation project : Integrated ADLs and IADLs Rehabilitation and Mobility Training Program for Dementia and MCI Elderly was launched.

Objectives :

(1)To implement a sustainable ADLs ,IADLs and mobility training program for target clients (2)To maintain target clients with ADLs , IADLs and mobility function (3) To promote the importance of ADLs ,IADLs and mobility training of MCI and dementia clients to care givers and health workers

Methodology :

A working group was set up for program design and coordination. This program is tailored made, client centered with proactive and systematic training sessions on everyday morning and evening for MCI and dementia clients for 12 months. Monthly training timetable and program pamphlets were distributed to clients and relatives. Workshop includes cooking class, computer class, hair grooming class, shirt and tie wearing class, clothes washing class, money management class, transportation orientation class. Besides, clients are trained with morning toilet ,make bed, wash utensils, clean up table routinely and learn the use of calculator, iPad and mobile app. Other ADLs and IADLs training include bowels , bladder , grooming, toilet use, feeding ,transfer , mobility ,dressing ,stairs and bathing, ability to use telephone, shopping, food preparation, laundry, responsibility for own medications and ability to handle finances Those tailored made training workshop and fulfilment standard were accordance with client’s ability and aptitude.

Result & Outcome :

From Oct 2017 to Oct 2018 , total 106 clients joined the program. Pre and Post assessment were conducted. Three assessment tools include Barthel Index of Activities of Daily Living ,Lawton Instrumental Activities Scale and Montreal cognitive Assessment ( MOCA ) with total 18 assessment categories were applied. Barthel Index showed the increase from 60% to 70 % of clients got 15-18 marks which indicates clients’ progress in grooming, toilet using and dressing .For IADLs findings, there were significant increase from 60% to 80% of clients got 16-18 marks which indicates the improving skill for clients in shopping, food preparation ,cooking and transportation. Nearly 95% of participants received the statistical difference among those pre and post assessments which showed our target group could maintain ADLs , IADLs and mobility function. 106 program evaluation forms with positive feedback were received. Both clients and relatives supported the program and relatives were willing to join the training classes with clients together . To conclude, this new rehabilitation approach to MCI and dementia clients are worthy to implement in psychogeriatric ward. This proactive and client centered training program is highly recommended to develop in Hong Kong.