Enhancing Medical-Social Collaboration : Volunteer-led Home-based Cognitively Active Lifestyle Program (V_CAL@Home)

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Authors (including presenting author) :
Poon A (1), Chan CW (1), Lee HS (1), Hui G (1), Wan SH (1), Ng SY (2), Chan SF (2), Sim TC (3), Sha KY (3)
Affiliation :
(1)Occupational Therapy Department (2) Health Resource Centre (3) Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Patients with cognitive impairment often encounter difficulties in managing their activities of daily livings which can affect their independence and increase the burden of care-givers. Those vulnerable patients identified with cognitive impairments and insufficient social support will receive home-based cognitive assessment and rehabilitation by occupational therapist in United Christian Hospital (UCH).Studies reveal that cognitively active lifestyle intervention – integrating cognitive training components into patient’s individual daily life routine, can achieve better clinical outcome as training is more accessible and patients are better motivated. Besides, it is also cost-effectiveness as care-givers or volunteers could be empowered through training to facilitate the development of the cognitively active lifestyle for patients.
Objectives :
A Volunteer-led Cognitively Active Lifestyle Home-based Program (V_CAL@HOME) was developed in November 2015 which aimed at i) developing a cognitively active lifestyle, ii) enhancing cognitive function, iii) reducing burden of the care-givers, iv) empowering patients and care-givers, and v) facilitating medical-social collaboration in development of volunteer support .
Methodology :
The V_CAL@HOME collaborative project consists of two components:Volunteer recruitment and training: volunteers were recruited from Kowloon East community partners. 2-session volunteer training was provided by occupational therapist and social worker of Health Resource Center (HRC), UCH which covered knowledge about cognitive impairment, communication skills, skills in providing cognitive stimulating & mind-body activities, handling personal data and infection control training. All volunteers must pass the cognitive impairment knowledge quiz and practical test.The V_CAL@HOME by trained volunteers: a weekly 45-minute home-based program delivered by trained volunteers for a total of 8-10 sessions to facilitate the development of a cognitively active lifestyle through engaging patients in OT-planned cognitive stimulating activities (orientation, attention, judgment, sequencing, calculation and memory), other mind-body activities like modified Health Qigong and for community support.Pre-test and post-test design was adopted. Outcome measures include cognition (HK-MoCA), Quality of life (WHO 5), care giver burden (Caregiver Strain Index), patient’s/care giver’s attitude toward community support and program evaluation questionnaire.
Result & Outcome :
From November 2015 to December 2018, 64 volunteers were recruited and trained from 9 Kowloon East community partners. 43 patients with cognitive impairment were recruited. Total 35 patients (10 male and 25 female) had completed the program. Their mean age were 84.9 (SD 5.0) and 42.9 % patients were day time alone. The mean received session were 9.7 (SD 1.7). Community support and activity engagement for those vulnerable patients were increased from 11.4% to 65.7%. Paired samples t-test revealed that there was significant improvement in HK-MoCA score from 10.4 to 10.8 (p=.002) and from 60.1 to 66.1 (p=.004) in WHO-5. Also, care-giver burden score was significantly reduced from 4.4 to 3.0 (p=.002) in Care-giver Strain Index. For the patient’s/care-giver’s attitude toward community support, the patient’s score was significantly improved from 10.2 to 17.3 (p=.00), and from 13.7 to 21.0 (p=.00) in care-giver’s score. Patients and care-givers were also very satisfied of the program. Conclusion: Cognitively Active Lifestyle intervention, the V-CAL@HOME program, provided to patients with cognitive impairment at home involving medical-social collaboration in volunteer support was effective not only in clinical outcome but also in continuity of training and in generalization of learning effect. It was also cost-effective. The scale of the program should be expanded to cover more patients in need. Further development of the medical-social collaboration care model should be explored for other disease groups as well.

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