Joanne Chung School of Nursing The Hong Kong Polytechnic University hsjchung@inet.polyu.edu.hk

Joanne ChungJoanne ChungSchool of NursingSchool of Nursing

The Hong Kong Polytechnic UniversityThe Hong Kong Polytechnic Universityhsjchung@inet.polyu.edu.hkhsjchung@inet.polyu.edu.hk

Ageing population

Challenges of the 21st Century

Sources of photos: Jockey Club Hong Kong and YahooSources of photos: Jockey Club Hong Kong and Yahoo

Foundation: Individual

Mobile Integrative Health CentreMobile Integrative Health Centre

Our Target: Deprived Groups

Unengaged

• not registered with any kind of networked programme under mainstream services; and,

• have genuine needs of support services; and,

• unmotivated to receive assistance

Partially unengaged

• has registered with a networked  programme under mainstream services before; and,

• have genuine needs of support services; and,

• unmotivated to receive assistance /services

Our Target: Deprived Our Target: Deprived GGroupsroupsUnique Unique FFeatureseatures

• Self care, family care and community care• Participative care focusing on empowerment• Evidence based and protocol driven services• Integrative Western, complementary and TCM practice,

and technology• Integrated cultural elements

Prevent unnecessary admission to hospitals and enhance independence by optimizing their living environment:

The The TTeam and eam and CCommunity ommunity PPartnersartners

Advanced Practice Nurse

Academics & Students

Medical Practitioner

TCM Doctor

Nutritionist IT

Engineer

Biostatistician

Researcher

Publicity Staff

Video Video CConferenceonference

Community partners (NGOs, Police, Estates, District Board)

Telehealth System(local server)

Individual & Family Health Profiling

Individual & Family Health Profiling

Community Health Profiling

Community Health Profiling

Health Health Statistics Statistics

CentreCentre

Health Health Statistics Statistics

CentreCentre

• Web-based Web-based Info CentreInfo Centre

• Health Health Promotion & Promotion & Education Education ActivitiesActivities

• Protocol Protocol developmentdevelopment

• Web-based Web-based Info CentreInfo Centre

• Health Health Promotion & Promotion & Education Education ActivitiesActivities

• Protocol Protocol developmentdevelopment

MIHC – the HubMIHC – the Hub

PolyU serverPolyU server

InterfaceInterface

Some SnapshotsSome Snapshots

Interview

Blood pressure measurementBlood oxygen saturation (SpOBlood oxygen saturation (SpO22))Pain assessmentPain assessment

Dental Assessment

Cognitive trainingFoot massage

Diabetes mellitus consultationDiabetes mellitus consultationVisual acuity assessmentVisual acuity assessmentConcentration and Concentration and

small muscle small muscle trainingtraining

Health educationHealth education

Nutrition talk with food samplesNutrition talk with food samplesPsychosocial counsellingPsychosocial counsellingExerciseExercise

Pain ManagementFollow up

Telehealth System(local server)

Individual & Family Health Profiling

Individual & Family Health Profiling

Community Health Profiling

Community Health Profiling

Health Health Statistics Statistics

CentreCentre

Health Health Statistics Statistics

CentreCentre

• Web-based Web-based Info CentreInfo Centre

• Health Health Promotion & Promotion & Education Education ActivitiesActivities

• Protocol Protocol developmentdevelopment

• Web-based Web-based Info CentreInfo Centre

• Health Health Promotion & Promotion & Education Education ActivitiesActivities

• Protocol Protocol developmentdevelopment

MIHC – the HubMIHC – the Hub

PolyU serverPolyU server

Health Profile

• Mobile Integrative Health Centre started its service on 16 Jan 2008

• 953 older adults (327 male, 626 female) registered for the service

@31 August 2008@31 August 2008

Age (years)Age (years)

Gender

Service location

Kowloon Bay(n = 417)

Sham Shui Po(n = 325)

Lai King(n = 209)

Mean S.D. Mean S.D. Mean S.D.

Male 75.6 7.1 73.7 5.8 71.7 7.0

Female 76.8 8.0 72.8 6.4 71.7 7.3

Social participationSocial participation

Participation

Service Location

Kowloon Bay (389)

Shum Shui Po (287)

Lai King

(209)

Unengaged 123 (31.6%) 7 (2.4%) 0

Partially engaged

8 (2%) 7 (2.4%) 0

Engaged 258 (66.3%) 273 (95.1%) 209 (100%)

10.6% of the older people in HK are unengaged (12 Jan 2008)10.6% of the older people in HK are unengaged (12 Jan 2008)

Source: http://www.takungpao.com.hk/news/08/01/21/GW-853769.htmSource: http://www.takungpao.com.hk/news/08/01/21/GW-853769.htm

5 major health problems5 major health problems

Major health problems

Location of service

Kowloon Bay (n=418)

Shum Shui Po (n=326)

Lai King (n=209)

Male Female Male Female Male Female

n (%) n (%) n (%) n (%) n (%) n (%)

Hypertension 65 (50.4)149

(51.6)52 (38.0) 91 (48.2)

21 (34.4)

79 (53.4)

Cataract 27(21.0) 73 (38.6) 22 (16.1) 37 (19.6) 8 (13.1)25

(16.9)

Diabetes mellitus

23 (18.0) 52 (18.0) 22 (16.1) 24 (16.7) 7 (11.5)19

(12.8)

Painful joints* 28 (21.8) 68 (23.5) 21 (15.3) 42 (22.2)13

(21.3)38

(25.7)

Hyper-lipidaemia

10 (7.8) 29 (10.0) 10 (7.3) 21 (11.1) 5 (8.2)16

(10.8)*include gout, degenerative joints and rheumatic arthritis

Mini Nutritional Assessment (MNA) Mini Nutritional Assessment (MNA) ScreeningScreening

MNA screening

score*

Service location

Kowloon Bay(n = 383)

Sham Shui Po(n = 300)

Lai King(n = 201)

n % n % n %

<12 127 33.2 96 32.0 40 19.912 256 66.8 204 68.0 161 80.1

* Subjects with Mini Nutrition Assessment (screening) score <12 is considered as possible malnutrition and require to conduct the further assessment.

Malnutrition Indicator Score (MIS)Malnutrition Indicator Score (MIS)

Malnutrition Indicator Score*

Service location

Kowloon Bay(n = 91)

Sham Shui Po(n = 39)

Lai King(n = 21)

n % n % n %

<17.0 5 5.5 3 7.7 4 19.017.0-23.5 80 87.9 32 82.1 17 81.0

>23.5 6 6.6 4 10.3 0 0.0

* Subject with MIS <17.0 is considered as malnourished and MIS 17.0 is considered as “at risk of malnutrition”.

Abbreviated Mental Test (AMT)Abbreviated Mental Test (AMT)

AMT score*

Service location

Kowloon Bay(n = 383)

Sham Shui Po

(n = 300)

Lai King(n = 201)

n % n % n %

<6 32 8.5 11 3.8 5 2.6

6 343 91.5 281 96.2 187 97.4

* Subject with AMT score < 6 is considered as possible dementia and further test such as Mini Mental State Examination (MMSE) is required. Subject with AMT score 6 is considered as normal.

Mini Mental State Examination Mini Mental State Examination (MMSE)(MMSE)

MMSE score*

Service location

Kowloon Bay(n = 26)

Sham Shui Po(n = 5)

Lai King(n = 4)

n % n % n %

<10 3 11.5 0 0 0 0

10-19 13 50.0 3 60 2 50

20-26 8 30.8 2 40 2 50

27 2 7.7 0 0 0 0

* MMSE score < 10 = Severe dementia, 10-19 = Moderate dementia, 20-26 = Mild dementia and 27 = normal.

Geriatric Depression Scale (GDS)Geriatric Depression Scale (GDS)

GDS Score*

Kowloon Bay (n = 356)

Sham Shui Po (n = 281)

Lai King (n = 188)

Male Female Male Female Male Female

n % n % n % n % n % n %

<8 90 85.7 214 85.3 106 86.2 132 83.5 53 98.1 119 88.88 15 14.3 37 14.7 17 13.8 26 16.5 1 1.9 15 11.2

•GDS score < 8 = without depression •GDS score 8 = depression

Activities of livingActivities of living

Activities of Living With problems (n, %)

Maintaining a safe environment 43 (4.9%)

Communication 36 (4.1%)

Eating and drinking 48 (5.5%)

Elimination 167 (19.1%)

Hygiene and grooming 11 (1.3%)

Mobility 125 (14.3%)

Working and entertainment 26 (3.0%)

Focus assessment

1. Concentration

2. Visual-spatial

co-ordination

Subjective Happiness ScoreSubjective Happiness Score

Subjective Happiness

Score*

Service location

Kowloon Bay(n = 372)

Sham Shui Po(n = 307)

Lai King(n = 203)

n % n % n %

4-7 4 1.6 3 2.0 3 1.78-14 22 8.7 12 8.0 12 6.8

15-21 92 36.2 50 33.3 57 32.2

22-28 136 53.5 85 56.7 105 59.3

* Subjective happiness score of 4 and 28 represent lowest and highest happiness respectively.

Dietary modification, education, dental care

Nutrition

Drug compliance, monitoring, exercise, education, diet

DM

Drug compliance, monitoring, exercise, education, diet

Hypertension Life long health record:a. self-administered health assessmentb. continuity of carec. participatory health management

Telehealth System ++

Bowen therapy, exercisePain

External

Internal