Roadmap of Sustainable Elderly Rehabilitation & Care, from GDH to Community Occupational Therapy Perspective

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Authors (including presenting author) :
EKH Leung(1), AFC Lau(1), JPM Tsang(1), TW Au Yeung(2)
Affiliation :
(1)Occupational Therapy Department, Pok Oi Hospital (2)Department of Medicine &Geriatric, Pok Oi Hospital
Introduction :
The elderly Services Programs Plan 2017 by Elderly Commission, HKSAR, has placed high priority in active aging and community care services. Spot light has also thrown to carer support and services for elderly persons with dementia. In the district like Yuen Long, for every 5 persons there is 1 above age of 60 and with the rise in life expectancy, it is expected the caring of the elderly especially with multiple co-morbidity is the major issue that needs to be handled. One of the major settings for the elderly rehabilitation is taken place in geriatric day hospital (GDH). Hence, GDH has a major role to carry forward rehabilitation from hospital and pass it onto the community partners.
Objectives :
1. To identify the common characteristics of the patients in GDH 2. To address the care and rehabilitation needs of the elderly discharged from GDH to Community
Methodology :
Review from the outcome database of GDH, POH from year of 2016 to 2018, the data for activities of daily living (ADL), and Instrumental ADL (IADL), cognition and hand functions and will be analyzed. Further subgroup analysis for Specialized Neurocognitive Rehabilitation (NCOG) will be administered. Functional needs of the elderly in GDH upon discharge will be identified.
Result & Outcome :
Comparison of Initial/ Discharge outcomes by pair sample T Test in MBI (full score:100) 72.38/76.72 (P<0.0001) Lawton IADL (full score:27) 7.11 / 8.2 (P<0.0001) AMT (full score:10) 6.56 / 6.97 (P<0.0001) Power grip (left) 16.38 kgf / 16.86 kgf (P<0.0001) Power grip (right) 17.39 kgf / 17.81 kgf (P<0.0001)
Selected outcomes in specialized NCOG program NCOG Group (N=54) Initial and Discharge outcomes by paired sample test P-value MoCA HK ver (full score:30) Total score 11.75 / 14.52 (P<0.0001) Sub score: delayed recall (full score: 5): 0.12 / 0.55 (P=0.018) Despite progress has been made in the course of rehabilitation in GDH, the elderly discharged need at least supervision in daily living with mean score of MBI lower than 80. They may experience decline in global function with hand grip strength <25 kgf in men and <18 kgf in women (Chen LK, 2014 and 2016) .From the review, the hand dexterity (NHPT) is also below the local norm reference for male elderly is R/L: 23.8/25.5 secs and female is R/L 23.1/23.5 secs. For adapted Lawton IADL, score lower than 9 means those elderly may need assistance in almost every aspect in IADL. The mean score of AMT near the cutoff score of 7(Lam S, 2010) need to keep cognitive active in order to retain their cognitive function. There is similar scenario in NCOG. They experienced poor short term memory even with active treatment. Hence, at the pre community phase rehabilitation program, the empowerment elements in elderly care should not be omitted. We should prepare caregivers to have complete view of the elderly functions and the importance in active daily living to tackle the deterioration. They should allow the elderly to participate in daily occupation. Community -based partners should continue support the self-management elderly care concept. Basic and essential care resourse and support should be available in community before the elderly enter the hospital system again. Reference Chen LK et al (2014) Sarcopenia in Asia: Consensus Report of the Asian Working Group for Sarcopenia JAMDA 15 (2014) 95-101 Chen LK et al (2016) Recent Advances in Sarcopenia Research in Asia: 2016 Update From the Asian Working Group for Sarcopenia JAMDA 17 (2016) 767.e1- 767.e7 Elderly Services Programme Plan - Elderly Commission 2017 Lam S (2010) RELIABILITY AND VALIDITY OF THE ABBREVIATED MENTAL TEST (HONG KONG VERSION) IN RESIDENTIAL CARE HOMES JAGS 58 (2010) 11 2255-2256

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