Authors (including presenting author) :
Chao FW (1), Au Yeung TW (1), Kwan YK (2), Leung KS (2), Wong WM (2), Chan T, (3), Lam YM (1), Lee MM (1), Kwok WY (1), Yiu D (1), Ng J (1), Chan BC (1), Wong MH (1).
Affiliation :
(1) Community Care Division, New Territories West Cluster (2) Department of Medicine and Geriatrics, Tuen Mun Hospital (3) Department of Medicine and Geriatrics, Pok Oi Hospital
Introduction :
In RCHE, elders suffering from dysphagia, leading to increase aspiration risk or poor oral intake, is common in Hong Kong. Tube feeding is an alternative for patients with dysphagia or poor oral intake to supplement nutrition and maintain calorie intake. However, there is no strong evidence that tube feeding can prevent aspiration or prolong survival. The patient or caregiver may opt for careful hand feeding despite high risk of aspiration. Careful hand feeding can be an effective mean of maintaining nutrition with comfort, pleasure and socialization for the elderly. The RCHE staffs are competent in providing of careful hand feeding through the empowerment by Community Geriatrics Assessment Team (CGAT) or Community Nurses (CN). Finally, the patient and caregiver can be cared by the collaboration of the health care team.
Objectives :
1. To facilitate the patients’ journey from hospital to community 2. To provide safe practice on the oral feeding for the elderly in the community 3. To improve and enhance caregiver’s feeding technique
Methodology :
1. CGAT nurses or CN provide transitional care to patient after discharge 2. Identify the suitable patients for End of Life program and provide the enhanced care. 3. Ensure both relative and RCHE staff understand the risk of oral feeding 4. Reinforce RCHE staff for safe and slow feeding and observe choking during oral feeding (Display the Speech Therapist guide (ST guide) or alertness of choking over the patient’s bed) 5. Reinforce the route of diet (Puree diet and thin liquid by default if no ST guide) 6. Provide ‘吞嚥食物困難 – 病人進食紀錄表’ (type of food, consistency, amount, any signs and symptoms of choking) for record keeping in RCHE 7. Monitor feeding behavior and process: -Identify person or staff for feeding -Monitor feeding technique -Monitor patient’s intake and output -Monitor body weight and with serum albumin regularly 8. Report the patient’s progress if any adverse effects or complications (e.g. fever, signs and symptoms of chest infection, persistent decrease of body weight and discuss any need to insert feeding tube or review by speech therapist) 9. Regular CGAT meeting for review of cases 10. Review the progress of nutritional status regularly 11. Arrange early follow up if necessary
Result & Outcome :
From Aug, 2019 to December, 2020 1. 130 patients were being recruited in RCHE (Mean age 85.5) 2. 88 patients were under Enhanced EOL program 3. 9 patients referred to EOL program upon discharge 4. 13 patients reviewed and upgraded to general oral feeding. 5. Overall patient’s nutritional status has been maintained
