Authors (including presenting author) :
Wong MY(2), Lau CC(1), Fan KY(3), Cheung WL(4), Yung IY(5), Hai MK(1), Tse LS(1), Ho KS(1), Law PL(3), Lam CMD(4), Koo LY(4), Chan SP(4), Chan NH(2), Mak MYM(3), Koo HW(5), Chan CH(1)
Affiliation :
(1) Department of Medicine & Geriatrics, Tuen Mun Hospital, NTWC (2) Department of Medicine & Geriatrics, Pok Oi Hospital, NTWC (3) Department of Physiotherapy, Tuen Mun Hospital (4) Department of Occupational Therapy, Tuen Mun Hospital (5) Department of Dietetic, Tuen Mun Hospital
Introduction :
Postural hypotension (PH) is characterized by a significant drop in blood pressure upon standing, leading to symptoms such as dizziness and syncope, which increase fall risk and reduce functional capacity. In hospitals, especially during acute illnesses or prolonged bed rest, these symptoms can worsen, extending hospital stays. Early identification and management of PH are crucial for better patient outcomes. To address this, a PH Management Program was piloted in nine Medicine and Geriatrics (M&G) wards at NTWC, utilizing a multidisciplinary team (MDT) approach and medical-social collaboration (MSC) for comprehensive care and post-discharge support.
Objectives :
The program aimed to: • Alleviate symptoms, maintain functioning, and prevent falls. • Enhance and standardize PH management. • Improve post-discharge support through MSC collaboration.
Methodology :
The program involved a MDT of geriatricians, nurses, physiotherapists, occupational therapists, and dietitians. They implemented intervention protocols promoting early mobilization for patients with PH. Interventions included medication adjustments, exercise prescriptions, ADL advices, assistive devices prescription, fall prevention strategies, dietary modifications, patient education, multidisciplinary rounds, and community linkages. During the pilot phase, patients were screened for orthostatic vitals based on PH symptoms, syncope, dizziness, falls, or PH diagnosis, excluding those requiring bed rest. Custom interventions with a MDT approach were tailored to individual conditions and capacities. Upon discharge, patients received personalized plans and educational materials for self-management, with ongoing support from community resources like District Health Centres (DHC), Geriatric Day Hospitals (GDH), and Integrated Discharge Support Programs (IDSP). A pre-test vs. post-test trial measured functional outcomes using the Modified Functional Ambulation Classification (MFAC), Elderly Mobility Scale (EMS), and Modified Barthel Index (MBI), along with a symptom questionnaire.
Result & Outcome :
From November 2023 to November 2024, 30 patients (27 males, 3 females; mean age 77.2±10.21 years) were recruited. Results showed that 65.5% improved in mean score by 30.7% on MFAC, 66% improved by 50.7% on EMS scores, and 68.9% improved by 17.2% on MBI. Additionally, 82.7% reported a decrease of mean score by 40% in symptom scores. a significant difference was observed in pre- and post-intervention in MFAC, EMS and MBI with p<0.05. Most patients maintained physical functions, with only 10% experiencing slight declines. No inpatient falls or unplanned admissions related to PH occurred within 30 days and six-months post-discharge. The program effectively alleviated symptoms, maintained functional capacity, and prevented falls. Feedback indicated increased awareness of fall prevention and improved self-management. Future studies should evaluate long-term outcomes, including hospital stay duration and post-discharge results.
