Authors (including presenting author) :
CHAN MW (1), Wan Sambo (3), Kwong Susane (3), Law Cherry (4), Ho Sabrina (2), Mak Flora (2), Kng Carolyn (2)
Affiliation :
(1) Department of Community Healthcare Services, Hong Kong East Cluster
(2) Department of Medicine & Geriatrics, Ruttonjee and Tang Shiu Kin Hospitals
(3) Department of Physiotherapy, Pamela Youde Nethersole Eastern Hospital
(4) Department of Dietetics, Pamela Youde Nethersole Eastern Hospital
Introduction :
Community nurse centers (CNC) supports hospitals to deliver secondary prevention and health maintenance in a primary care setting, being located in housing estates with elderly population along with various NGOs, making it well placed for medical-social collaboration. Sarcopenia is an age-related progressive disorder defined by loss of muscle mass, up to 15% at 70 years which further increases by age. It is strongly associated with falls, fractures, functional dependence and increased mortality.
Objectives :
Instead of using precious hospital based rehabilitation resources, the primary objective of this study examines the feasibility and effectiveness of delivering Sarcopenia interventions which is co-designed with multidisciplinary input and delivered by nurse in district settings.
Methodology :
Screening for Sarcopenia was conducted for elders attended a district-based CNC in Yue Wan Estate during June 19 to August 19 using a validated simple 5 item symptoms tool called SARF-C which if positive, will lead to a bundle of further assessments including Handgrip Strength, Gait Speed Test, Chair-to-Stand Test, Skeletal Muscle Index (SMI) and the Balance Test to confirm the diagnosis. Intervention consisted of an invitation to elders with confirmed Sarcopenia to join a 12 weeks structured multi-disciplinary training program held at CNC.
Result & Outcome :
Total 264 cases screened, with 87 cases (32.6%) SARF-C score was ≥ 4 which indicated at risk of Sarcopenia, who then had the bundle of assessments. 16 cases (18% of at risk group and 6% amongst original population) were classified as Sarcopenia according to definition.
The 16 confirmed cases attended a 12 weeks training class co-designed by nurse, physiotherapist and dietitian covering various aspects of functional trainings, nutrition advices and disease management. “My Sarcopenia Dairy Booklet” was issued to each participant as health education booklet and continuous self-monitoring record. 3 participants dropped-out because 2 was admitted to hospital being discharged to aged home, 1 quit due to lower limbs pain.
After 12 weeks training, same bundle of assessments were re-applied to the 13 successful candidates upon completion for comparison. The overall performance had improved in Left Handgrip (108%), Right Handgrip (106.8%), Gait Speed (82.8%), Chair-to-Stand (68.4%), Balance Test (86.9%) and SPPB Score (175%) respectively.
Knowledge and awareness enhancement on Sarcopenia were positively reflected in the pre vs post questionnaire. A reduction in fall incidence was also noted.
Conclusion
This innovative nurse-led model of care in district setting empowered by hospital-based multidisciplinary team is a benchmark for much needed primary care development in Hong Kong to deal with ageing population. The Sarcopenia program is effective in enabling evidence based exercise and dietary interventions with significant improvement in handgrip strength, gait speed, performance scores in balance and muscle performance, along with patient empowerment and importantly, in adverse consequence such as falls. Further plans for medical social collaborative partners such as NGO are in place.
