Authors (including presenting author) :
Tam CY (1), Chueng DSK(2), Kwan RYC(3), So DKY (1), Yeung, CS (4)
Affiliation :
(1) Accident and Emergency Department, Queen Elizabeth Hospital, (2) School of Nursing & Midwifery, Deakin University, Australia, (3) School of Nursing, Tung Wah College (4) Physiotherapist Department, Queen Elizabeth Hospital
Introduction :
Recent systematic reviews have shown that older adults with cognitive frailty are more likely to develop dementia and experience falls than those with frailty alone. Motor-cognitive training effectively reverses and prevents further deterioration of cognitive function, frailty status, and physical function in older adults with cognitive frailty. Ageing populations have heavier demands on the health care system, especially the emergency department, which provides 24-hour services. Older people have a higher rate of emergency attendance and a longer stay relating to more life-threatening conditions, and a higher admission rate in the Accident and emergency department (AED) than the younger patients. Older adults are unaware of the risk of decline and loss of dependency. They are more vulnerable to stressors, which leads to a higher rate of adverse health outcomes after being discharged from AED. The current time-pressured Accident and Emergency Department (AED) setting is challenging for practitioners to provide an intervention to maintain or improve the current physical and cognitive function of these older adults with non-acute complaints and prone to further deterioration after AED discharge. There is a mismatch between the services offered by traditional emergency medicine and the demands of the elderly population. Specific intervention is required to better target the needs of these older adults. Based on a systematic review and previous literature, motor-cognitive training is an essential intervention component. However, the effects of motor-cognitive training in a home setting are unknown.
Objectives :
This study aims to evaluate the effectiveness of the interventions on (1) cognitive function, (2) physical function and (3) frailty status.
Methodology :
This study is a single-blinded pilot randomised controlled study. Subjects were allocated to either the intervention or control group in a 1:1 ratio, receiving motor cognitive training in addition to usual care or usual care only. The programme targeted older adults aged 60 or above with cognitive frailty who had been discharged from the AED. The intervention lasted 12 weeks, with three 90-minute sessions (60 minutes of physical activity and 30 minutes of cognitive training) per week. The outcome was intervention efficacy, which included physical frailty level, physical performance, cognitive function and reattendance and readmission rate. Data was collected at two-time points: baseline and post-intervention. The findings of the study might help improve the actual research and provide evidence for implementing motor-cognitive training for AED discharged older adults with cognitive frailty.
Result & Outcome :
Forty participants consented to participate and were randomised into either the intervention group (n=20) or the control group (n=20). Although no change in physical frailty level was observed in the study, the intervention group had improved in physical performance and cognitive function. A larger effect size was observed in the intervention group than in the control group in a few cognitive function domains, including global cognition, episodic memory, and verbal and executive control activity. However, the differences were insufficient to achieve statistically significant differences between groups. There are statistically significant differences in post-intervention assessment between the two groups for Moderate-Vigorous Physical Activity (MVPA). The intervention group was noted to have higher MVPA than the control group in the post-intervention assessment. The intervention group improved in the Six-Minute Walk and Time-Up-To-Go tests. One out of the 20 cases (5%) in the intervention group had reattended AED and was admitted once within the month after post-follow-up, in which the figures are much lower than in previous studies. This study provides preliminary evidence that e-health enhanced sequential motor cognitive training effectively enhances the cognitive function, physical performance, and physical frailty of older people with cognitive frailty.
This is a pilot study. A further study with a larger sample size would be beneficial in evaluating the effects of the training intervention. E-health is the current trend for developing virtual geriatric emergency services. Virtual geriatric clinics started to develop during the COVID-19 period. The Hospital Authority Strategic Plan 2022-2027 aims to provide smart care and develop smart hospital services in the future. E-health enhanced motor cognitive training shows a preliminary effect on cognitive and physical performance, paving the way for a smart platform connecting hospital services with home settings for the elderly.
