Authors (including presenting author) :
Carrie Tang (1), Chan WY(1), Cheung TY (1)
Affiliation :
(1) Occupational Therapy Department, Tuen Mun Hospital
Introduction :
The ICM - Case Management (CM) program provides transitional and integrated support services for high-risk patients aged 60 or above upon discharge. The primary goal is to facilitate independent living, enhance patient safety, and reduce the likelihood of readmission. A local study showed the prevalence of ‘very mild dementia’ and mild dementia for people aged 70 years or above was 8.5% and 8.9% respectively (Lam et al., 2008). Within the ICM-CM program, patients often report subjective memory complaints, such as forgetting appointments and facing challenges in adhering to medication schedules. With progressive cognitive decline, dementia-related memory impairments can significantly disrupt daily functioning. Therefore, preventive measures, especially during the mild cognitive impairment (MCI) phase, are crucial in dementia care (Petersen et al., 2001).
Objectives :
- To review the effectiveness of gerontechnology prescription and enhanced medical social collaboration for patients with cognitive impairment under ICM-CM program
Methodology :
Medical social collaboration involves cooperative efforts among individuals, families, and organizations to achieve shared goals. Enhanced collaboration strategies included the prescription of gerontechnology, increased family involvement, and exploration of new social services to support patients with cognitive impairment in living independently and safely at home.
Occupational therapists (OTs) in ICM CM program team assess patients' cognitive capacities, functions, and problems encountered in home care. Transition of care interventions would be coordinated with HST for patients identified as unsafe in instructmental ADL (IADL). Recommendations for ADL aids and home safety measures were provided, followed by home based rehabilitation focusing on functional and cognitive training to enhance patients' safety at home.
Gerontechnology for cognitive impairment included supportive devices and surveillance technologies. These gerontechnology commonly served multiple functions. They encompassed prompting and reminding individuals with cognitive impairment, monitoring them at home through environmental sensors and biosensors, and ensuring outdoor safety. The formats included wearables, smartphone apps, client centered prompting tools, other supportive devices, and environmental sensors/ AI systems. For instance, environmental sensors such as motion, pressure, smart contact and fall detection sensors, enabled continuous monitoring of patients with cognitive impairment at home. Wandering, a prevalent risky behavior among patients with cognitive impairment, was often addressed through tracking devices and smartphones equipped with GPS or location monitoring apps.
Gerontechnology allowed family members to remotely monitor patients with cognitive impairment, reducing caregiver burden and enhancing patient safety. Family members could assist in device maintenance and management, supporting both patients and caregivers in the process.
However, some patients might struggle with or resist using new technology, while others lack social support for gerontechnology monitoring. Timely case conferences and referrals to long term care services were arranged for patients with poor rehabilitation potential. However, patients with a sole cognitive deficit may not qualify for long term care services, and the waiting time for Integrated Home Care Services (IHC) is lengthy. There was a service gap between completion of ICM service and long term social services. Therefore, other social initiatives are necessary to aid individuals in aging in place. For instance, the Senior Citizen Home Safe Association provided medication reminder services. Joyous Senior Life and Neighbourhood Advice Action Council offered ongoing home support. The Jockey Club Centre for Positive Ageing provided free tracking devices, and programs like "Sending Warmth to Thousands with Smart Technology" by Towngas offered smart controllers for cooking appliances.
Result & Outcome :
An evaluation of this model of service, which was initiated in April 2023, was conducted. Selection criteria included (1) patients with diagnosis of neurocognitive disorders or subjective memory complaints; (2) individuals who lived alone, daytime alone or had limited social support; and (3) those residing at home throughout the program. A total of 13 patients met the eligibility criteria for the service review.
62% of the patients were diagnosed as neurocognitive disorders, of which 50% as Dementia, 12.5% as MCI, and 37.5% were categorized broadly under cognitive disorders. 69% of the patients lived alone while 23% of the patients were daytime alone. 8% of the patients lived with a spouse who was also suspected of having cognitive impairment. The baseline assessment revealed an average score of HK MoCA 10.6, mBI 85.9, and the Lawton IADL Scale 6.2.
92% of the patients were prescribed with supportive devices to enhance safety in IADL. Among 85% of the patients identified as having family members for monitoring the surveillance devices, 60% of them arranged surveillance devices. All of them reported and prevented home accidents. While 10% of the patients declined and 30% of the family members refused to provide support to the patients.
For the 40% of patients who did not arrange surveillance devices and 15% of all patients without family support, timely referrals to long term care assessment, IHC service or other community initiatives were arranged. In the Tuen Mun district, the estimated waiting time for IHC was approximately 6 months while that of CCSV was around 3 to 4 months. Through this program, support from family members and/or the community were guaranteed and the duration of ICM services was reduced to an average of 11.7 weeks. Furthermore, there was a decrease in unplanned admissions within 3 months following ICM discharge.
Upon the completion of the ICM-CM program, the average score of the HK-MoCA was 11.4, of which 46% of patients showed improvement, 39% remained unchanged and 15% with deterioration. The average scores of the mBI and the Lawton IADL Scale were 94.9 and 10.3, respectively. In general, not only did HK-MoCA scores improve, but the functional scores also showed improvement. Additionally, incidents of missing dose observed were reduced.
Through collaborative efforts of medical social services and the implementation of gerontechnology, all patients were able to safely continue aging in place for an extended period.
