Evaluation of a pilot project on “Fall prevention as early discharge support initiative for elderly with falls discharged from Accident & Emergency Department (AED)”

Abstract Description

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Authors (including presenting author) :

Wu SW (1), Lam HY(1), Li KM(2), Wong SW(3), Wan SH(4), Chao VK(5), Chan PF(5)

Affiliation :

(1) Allied Health Clinic—Fall Prevention Clinic, Kowloon East Cluster (KEC) (2) Accident and Emergency Department, United Christian Hospital (UCH) (3) Physiotherapy Department, UCH (4) Occupational Therapy Department, UCH (5) Department of Family Medicine & Primary Health Care, KEC

Introduction :

Attendance in AED in relation to elderly fall increased significantly annually in Hong Kong. Many of the elderly falls caused serious injuries and decline in patient’s functional mobility and lead to extra burden in our health care system. Early discharge support for elderly discharged from AED after fall is therefore important in preventing future falls and thus decrease avoidable AED attendance and hospitalization.

Objectives :

To review the effectiveness of the early discharge support fall prevention intervention through collaboration between KEC Fall Prevention Clinic (FPC) and UCH AED.

Methodology :

This initiative involving collaboration between KEC FPC and UCH AED was implemented in December 2017. It aimed to provide early fall risk assessment and preventive intervention by physiotherapist and occupational therapist for elderly with fall discharged from UCH AED and fulfilled pre-defined referral criteria. Early appointment would be arranged by FPC and comprehensive fall risk assessment and stratification by FRASE would be conducted. Patients with low and medium risk would be recruited into FPC program while those with high risk would be referred out to Geriatric Day Hospital for more intensive intervention. After completion of the FPC program, number of fall related AED admissions, Bergs Balance Scale (BBS), Functional Reach Test (FRT), Fall Behavioral Scale (FaB) would be re-assessed.

Result & Outcome :

99 patients were referred to FPC from December 2017 to November 2018. 67 patients (35 male, 32 female; mean age 83) completed initial assessment. 86.6% patients were recruited into FPC program. 31 patients had completed FPC program. Number of fall related AED admissions was significantly reduced at 6 month (P< 0.001). There was also significant improvement in FRT (P=0.031) and FaB (P< 0.001) but not in BBS (P=0.343) at 1 month. The Early discharge support fall prevention initiative between FPC and AED was in reducing the number of fall related AED admissions, fall related risky behaviors and improved functional balance in elderly fallers.