Introduction
Falls are a major cause of morbidity and mortality in the older population. Among the community-dwelling elders of age 65 and above in Hong Kong (HK), the fall rates range from 20%-30% and are higher after age 75 (Chu, Chi & Chiu, 2007; HKSAR, 2012). Among those who fall, about 75% would sustain an injury and admit to hospital or residential care home (HKSAR 2016). Falls are not a normal part of ageing. They do not “just happen” but are resulted from the interactions of biological, behavioural and environmental risk factors. Among these factors, home hazards play a significant role, associating with a 38% increased risk of falls (Letts, Moreland & Richardson, 2010). In preventing and reducing elderly falls and the fall-related morbidity and mortality, modifiable risk factors are intervened through behavioural and home-based environmental modifications with booster follow-up home visits to maintain the effectiveness (Chu, et al., 2017). Touching the northern boundary of HK, North District of the New Territories is a rural area with a population of 320,000 which North District Hospital (NDH) serves. Among the residents, 11.1% are elders and 20% are scattering in 117 villages where the traditional cultural habits of the region are the most maintained (HKSAR, 2015). As such and to be effective, the fall prevention interventions have to accommodate the remoteness of the elders’ residence as well as their unique cultural and daily living habits.
Objectives
To provide care-in-place for elders at risk of domestic falls, a medical-social collaboration project was put into pilot for two years to support safe living at home for the elder patients discharged from NDH. Home safety devices are installed and potential risks are eliminated to prevent falls and reduce injury severity such that hospital admissions due to falls at home were prevented. Follow-up on the implementation of the fall prevention measures prescribed by occupational therapist was supported through volunteers.
Methodology
Led by occupational therapists, care-in-place was realized by integrating medical and rehabilitation services with home care upon empowering a non-government organization (NGO) in the community such that the therapist-prescribed fall prevention measures were reinforced in implementation by and in the elder patients’ homes through the neighbourhood young-old volunteers of the local community. With this intersectoral collaboration, leverage was offered through pooling the expertise and resources of the hospital with NGO to generate better service in an accessible manner.
Results & Outcome
190 hospital-discharged elders aged 60–97 were served for six months or more in fifteen project months, with 57 (30.00%%) aged 60-75 and 133 (70.00%) aged above 75. 1,826 home safety devices of 32 types were delivered. 524 home visits were made by occupational therapist. 282 friendly visits were paid by volunteers, averaging to 1.5 visits per patient. Of the patients served, 3 died from medical illnesses. 26 (13.90%) reported falls at home, indicating a relatively lower incident rate than their well community-dwelling peers. Among these elders with falls, 22 (84.62%) were admitted to hospital. Being older (>70) and at the time just after discharge from hospital might pose them at a higher fall risk than their peers. Referencing to the global and local fall incidence of community-dwelling well elderly, the project outcomes were encouraging. Upon the support for safe living, the elders can enjoy life in their own natural home environment. Being familiar with the local culture and daily living habits, the project experience showed aptness of the young-old volunteers in communicating with, understanding and encouraging the elders in the service process. Involving them did significantly enhance the service effectiveness and acceptability intended of the project. For the local community, a network system of neighbourhood volunteer support has also emerged.
Co-location with:
