Authors (including presenting author) :
Chan WGG(1), Au Yeung YKB(2), Lee J (1)
Affiliation :
(1) Podiatry Department, CMC
(2) Quality and Safety Unit , CMC
Introduction :
Given that local and overseas guideline for fall prevention in elderly has recommended that elderly patients should receive both education on footwear safety and assessment for foot problems.
However, detailed analysis on the epidemiology of foot problems related to fall has never been conducted in Hong Kong. A pilot study was conducted in order to look into the common foot pathologies presented by elderly patients with fall incidence. In CMC, the implementation of Morse fall scale for adult patients came into effect on 18 December 2017. Since foot assessment is not included in the fall risk assessment. The finding of this study will provide supporting evidence in the future establishment of referral indicators to Podiatry for patients with a high risk of fall.
Objectives :
1.Identify the common foot pathology in elderly from M&G with falls incidence during hospitalization
2.To establish a referral criteria to podiatry for patient with high risk of fall.
Methodology :
From October 2017 to April 2018, subjects with age at or above 65 with incidence of fall during hospitalization were referred to Department of Podiatry for foot assessment by the Q&S team. The Podiatrist arranged to carry out the assessment within 2 working days upon receipt of the referral.
All foot pathologies identified by the podiatrist were recorded in a foot pathology checklist designed by the Department of Podiatry. The reliability of the foot problem checklist was determined in a pilot study, the intra-class correlation coefficient for the inter-examiner assessment of the checklist was 0.97 (95% confidence interval = 0.89-0.99) and the Cronbach’s alpha was 0.97. Parameters including presence of foot pain, muscle power, ankle joint range of motion and hallux valgus angle were documented. Patient data including age, gender, BMI, medical history, type of footwear, level of foot care, their mobility, location and reasons of fall were recorded during the assessment.
All the assessment were conducted at patient bedside. Data analysis was performed using SPSS version 23.0 (SPSS Inc., Chicago, IL, USA).
Result & Outcome :
A total of 43 subjects were recruited in the study. The average (S.D.) age of the subjects was 81.5 (7.25) in which 69% were men. All 43 subjects recruited for this study presented with at least 1 foot pathology. The mean (SD) number of foot pathology identify in each subject was 5.5(2.1). 95% of subjects were found to have footwear problems.
The top 6 common foot pathology in the elderly are: Skin problems (93%), Ankle equines (93%), Nail pathology (77%) Lower limb Muscle wasting (74%) Foot/toe deformity (70%)and Reduced lower limb muscle power (70%)
33% of elderly experience different level of foot pain. The POD referral criteria for patients with high risk of fall is established as follow: 1. MFS≥45 AND
2. Active wound on foot and ankle OR
3. Foot and toes deformity OR
4. Toe nail deformity At the present time, footwear assessment is not included in the fall risk assessment of the patients.
In order to enhance staff awareness of the importance of appropriate footwear, establishing regular education sessions for both nurses and health care professionals is recommended. It is recommended that patients presenting with complex foot problems, should be referred directly to Podiatry for both assessment and education
Co-location with:
