Authors (including presenting author) :
YU ON, SO TWP, WONG MK, LEUNG KW, KWUN TM, HO WK
Affiliation :
Occupational Therapy Department, North Lantau Hospital (NLTH)
Introduction :
Fall prevalence and consequences in elderly population is well documented. Capturing and analyzing Lantau fallers’ unique characteristics supports more valid service planning on fall risk reduction and safe daily living upon discharge.
Objectives :
To explore specific needs of fall patients for the enhancement of OT fall intervention program.
Methodology :
A retrospective review of EM ward patients referred for OT fall intervention from 1st September 2018 to 30th August 2019. Demographics, fall history (in recent 6 months) and functional outcomes were collected. The model of “Person-Environment-Occupational (PEO)” was adopted to stratify patient’s fall risks. 3-months follow up on fall related re-admission was conducted via Clinical Management System.
Result & Outcome :
56%(n=149) subjects were female. 44% were 80-90 years old. Most of them living at home (89%), within which 12% living alone while 26% were daytime alone. 26% living at remote Lantau Island without any home support services. 89% of subjects considered as higher fall risk (Morse Scale > 45). 45 subjects reported fall incident(s) within six months (4.5% had 2-3 falls and 1.3% had more than 4 falls). Major reasons of fall were dizziness (35.5%) and attempted high risk behaviors (24.5%) e.g. attempting activities of daily living (ADL) despite of low functional capacity. 62.2% fell at home and majority occurred in toilet/bathroom (57.1%). In outdoor environment, patients fell mostly at pavement (47%), shopping mall (23.5%), public transportation (17.6%), step/stairs and park (5.9%) accordingly. Their mean Modified Barthel Scale (MBI) score was 77. 68% required assistance in ADL but 53% still traveled outdoor regularly. 34.3% scored below second percentile with Montreal Cognitive Assessment (HK-MoCA 5) which indicated likelihood of dementia. Under PEO model, top three leading-to-fall factors were “impaired standing balance & muscle weakness (96.7%)”, “dragging (39%)” and “inadequate ADL performance (36.9%)”. 88.6% had no fall-related readmission to NLTH three months post-discharged. NLTH EM patients showed higher fall rate when compared to locally available statistics, 30.2% versus 24.8%. Despite of their higher functional status, they encountered higher challenge in living at remote community with lesser support. The “PEO” model stratifies fall risks more systematically and identify specific patient needs that we have to focus more. The comprehensive fall profile also imposes awareness on other fall-contributing factors such as cognitive function, home environment design, demands in community living as well as leisure activities. The continual enrichment of a designated dataset for fall patients with emphasize on individual’s functional status, personal engagement in daily/community living activities and the design of high risk home environment shall facilitate therapist’s formulation of timely & effective management plan.
