Authors (including presenting author) :
WONG AMS(1), Chan ACM(1), Chan DWL(1), Wong GCK(2)
Affiliation :
(1)Physiotherapy Department, (2)Accident and Emergency Department, Queen Elizabeth Hospital
Introduction :
Aging population has high risk of fall and its consequences may be costly, disabling, and even life-threatening for some frail elderly. Fall recurrence is also common and its subsequent injuries further increase burden on our existing health care system. Physiotherapy Department has piloted an enhanced fall prevention program for elderly fallers with minor injuries admitted in Emergency Medicine (EM) wards of the Queen Elizabeth Hospital since August 2018. This program provides tailored made reconditioning program to build up muscle strength, improve balance control and maintain physical activity of patients. It helps to mitigate fall risk of elderly, reduce their ‘fear of falling’, and improve their functional independence and confidence. Reducing further fall incidents in this group of high risk fallers may lead to decrease their visit in Accident and Emergency Department and subsequent hospitalization. The program includes proactive screening of patients with early physiotherapy inpatient intervention and education, followed by home-based exercise program and Domiciliary Physiotherapy service.
Objectives :
The aim of this pilot study was to evaluate the effectiveness of the enhanced fall prevention program for elderly in EM wards.
Methodology :
This is a pretest-posttest quasi-experimental design. Patients admitted to the EM wards of QEH with the diagnosis of ‘fall’ or ‘fall with minor injuries’ were invited to participate in this program. All participants received an early physiotherapy inpatient intervention and education; followed by 12-week home-based exercise program of lower limb strengthening exercises, balance training and sitting Taichi for fall prevention. Domiciliary Physiotherapy service was also arranged for four times during the home-based rehabilitation period to monitor the exercise adherence, and provide evaluations on home safety and accessibility including outdoor mobility. Outcome measures including 30-second Chair Stand Test, Berg Balance Scale (BBS), Timed Up and Go Test (TUGT), fall and re-hospitalization episodes, and Chinese translated Activities specific Balance Confidence (ABC-C) scale were assessed at baseline and at 3-month upon completion of the entire training program. Patient’s satisfaction over the program was evaluated by Patient’s Satisfactory Survey. For statistical analysis, Paired Sample t-test was used for the within group pre-post comparison.
Result & Outcome :
Twelve patients (mean age=87.1±6.2 years old) completed the program. Statistically significant improvements in BBS (p<0.05), TUGT (p<0.05) and ABC-C scale (p<0.05) but not 30-second Chair Stand Test were noted for the fallers between baseline and 3-month measures. Nil fall and re-hospitalization episodes were recorded during the intervention period for all patients. Patients were generally satisfied with the program content, arrangement and mode of delivery. This study shows that the enhanced fall prevention program for elderly in EM wards appeared to have benefits to improve balance performance, functional independence and confidence, as well as reduce fall risk and prevent recurrent fall and re-hospitalization of the elderly.
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