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Joanne ChungJoanne ChungSchool of NursingSchool of Nursing
The Hong Kong Polytechnic UniversityThe Hong Kong Polytechnic [email protected]@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