Authors (including presenting author) :
Lo WY (1), Lam SHC (1), Jim HYB (1), Fung YCE(1), Cheung TYJ(1), Chan WY(2), Cheung SYR(3)
Affiliation :
(1) Occupational Therapy Department, Tuen Mun Hospital; (2) Occupational Therapy Department, Tin Shui Wai Hospital; (3) Department of Family Medicine and Primary Health Care, New Territories West Cluster (NTWC)
Introduction :
Around half of community elderly reported subjective memory complaints (SMCs) and fear of developing dementia. Epidemiology studies showed around 8% of this group were latent dementia and 16% were at particular high-risk i.e. mild cognitive impairment (MCI). Service gap existed for early diagnosis and timely intervention. Cognitive Assessment and Empowerment Program (CAEP) was developed to fulfill this gap in New Territories West Cluster since 2016.
Objectives :
To review the effectiveness of CAEP by occupational therapy (OT) for MCI patients and significance of CAEP in seamless management of patients with dementia.
Methodology :
Patients aged ≥ 60 with SMCs were recruited through GOPC referral. OT assessment, including cognition (HK-MOCA), functionality (ADLQ-CV), quality of life (QOL-AD) and dementia staging (CDR), was conducted prior to Family Medicine (FM) consultation for diagnosis. All recruited patients attended OT educational talks on Neurocognitive Disorders (NCD). Empowerment groups were arranged for MCI-diagnosed patients to promote cognitive stimulating lifestyle, risk factor controls and social well-being. Patients with significant behavioral and psychological symptoms were triaged by OT for early FM appointment. Bi-monthly multi-disciplinary (Geriatricians, FM doctors and OT) case conference were held to fast track complicated patients to SOPD. Half-year reviews were scheduled to monitor cognitive and functional status of MCI patients.
Result & Outcome :
In 2017, waiting time of CAEP was reduced by 61.8% and secondary-care referral rate by 38.9%. From Jan 2017 to Oct 2019, 1150 patients were recruited into CAEP and underwent OT assessment. 488 (42.4%) attended empowerment group training. 235 patients completed half-year review and 47 completed one-year re-assessment. Improvement were shown in self-management knowledge (average KAP: 4.41 to 4.50), cognition (average HK-MOCA: 20.89 to 20.97) and functionality (average ADLQ-CV: 10.18 to 10.89) upon completion of empowerment groups in half-year review. 87.6% patients were well maintained in community during the monitoring period. 281 patients were triaged for early FM appointment. Progress of those patients were followed-up by OT until specialists’ appointments were available. 55(19.6%) cases who would benefit from pharmacological intervention were selected and presented in 20 tele-conferences. Waiting time of 40 cases to SOPD was shortened from 26 weeks to 8 weeks through fast track pathway of Geriatricians.
