Occupational Therapy Service for Frail Elderly at Accident and Emergency Department

Introduction

With more elderly attending Accident and Emergency Department(AED), attention to common frailty syndromes has the potential to improve their outcomes in AED. Occupational therapist(OT) may help to identify their needs and offer support to enhance safe discharge to home. A pilot OT Frail Elderly Program(FEP) at AED of QMH composes of (1)OT screening at risk elderly at AED and (2)OT follow up for elderly with risk of fall or functional decline is developed. Patients underwent screening with fall risk or functional decline risk criteria achieved were triaged to different OT follow up interventions.

Objectives

To evaluate the potential of OT in AED to facilitate safe discharge of frail elderly from AED and to reduce their revisit to AED in six months.

Methodology

Between December 2017 to December 2018, a convenient sample of elderly visited AED of QMH with age above 75 years, lived at home with AED triage category 4 or 5 were screened by OT once a day. Patients with high fragility risk, having fall risk or functional decline risk, and discharged directly from AED were recruited. OT interventions which promoting active lifestyle and activity engagement; resolving risky behavior by multifactorial approach; promoting caregiver’s understanding of the concept of safe & active lifestyle, facilitate frail elderly to build up their reserve. Number of patients revisited AED in six months was retrieved from Clinical Management System. Association of OT follow up with repeated presentation to AED in six months was analyzed between groups of patients with and without OT follow up by independent t test.

Results & Outcome

Total 111 patients were screened with mean age 83.2 years, 57(51.4%) patients discharged from AED. 25(43.8%) patients received OT follow up and 32(56.2%) patients declined service. No significant difference in baseline performance between these two groups. Results showed that significantly less patients who received OT follow up(4, 16%) revisited AED in six months as compared with those without OT follow up(15, 46.8%) (p=0.014). This preliminary finding shows that OT follow up is associated with less revisit to AED in six months due to fall or deconditioning. This suggests that a short but individualized OT intervention might reduce vulnerable of fall and deconditioning in frail elderly.