Page 89 - HA Convention 2015

Special Topics

ST2.2 Nursing — Rehabilitation and Elderly Services 13:15 Theatre 1

Ambulatory Care for Demented Elderly Monday, 18 May
Liu HMS
Nursing Services Division, Wong Chuk Hang Hospital, Hong Kong

In view of the rapid ageing population in Hong Kong, there will be relatively more elders at risk of dementia. Dementia is one
of the main causes of dependence and disability at old age. These contribute to unnecessary or premature institutionalisation
of the patient (Yaffe et al. 2002). The burden to family members as well as health and social care systems are increasing.

In response to the public demands on personal, cognitive and social rehabilitation services to patients with dementia,
Dementia Day Care Centre (DDCC) was set up in November 2000 to provide cognitive stimulation to the demented elders and
to help relieving their family members from intensive day-caring burden. The dementia day care services, in the first place,
were designed mainly for patients with mild to moderate level of cognitive impairment. In view of the increasing demand
from the community for a more intensive service on advanced pathology, the Dementia Day Care Centre has extended the
services to cover the needs of those patients with more severe level of cognitive impairment since June 2013.

The team has provided non-pharmacological therapeutic training through multidisciplinary approach. It incorporates
cognitive training and physical activities within a group-based social context, providing comprehensive family support with
knowledge and counselling for those patients residing in community with mild to advanced cognitive impairment.

The multidisciplinary approach in non-pharmacological therapeutic training is evidenced in improving demented elders’
cognitive functioning and functional mobility, while also maintaining an optional optimal psycho-social functioning.
Subsequently, their caregivers can continue to take care of them at home and the demented elders can remain living in the
community for as long as possible. The healthcare burden can therefore be relieved.

ST2.3 Nursing — Rehabilitation and Elderly Services 13:15 Theatre 1

Empowering Older Adults on Drug Adherence — a Collaborative Service Model HOSPITAL AUTHORITY CONVENTION 2015
Cheng PPP
Central Nursing Division, Yan Chai Hospital, Hong Kong

Older adults have multiple pathologies; they have increased prevalence of chronic diseases and drug consumption. These
factors predisposed them to suffer from drug interactions and adverse drug events which can cause serious consequences.
In addition, older adults may have non-adherence problems which may lead to inappropriate use of emergency service and
avoidable readmissions.

Non-adherence to medication is a common problem among older adults with chronic conditions. To improve patients’
drug adherence, it is important to understand why non-adherence occurs. The causes are multifactorial and complex.
A substantial amount of literatures have listed several factors related to medication non-adherence, they include poly-
pharmacy; inadequate knowledge about the treatment; negative consequence of drug effect; and excessive complicated
regimen.

Medication management is not only a part of pharmaceutical care, it is also a primary care issue. Nurses are obligated
to assess patients’ response to pharmacological intervention and evaluate the implications related to patients’ treatment
outcome. Hence, we play a crucial role in patient empowerment on medication management.

A collaborative service model on Pharmacotherapy Patient Empowerment (PPE) to older adults is newly established. It is
a multidisciplinary service consisting of physicians, nurses, clinical pharmacists and the Integrated Care and Discharge
Support for the elderly (ICDS) team. In ward, ICDS nurse would apply the Morisky Medication Adherence Scale (MMAS-4)
to identify cases with risk of drug non-adherence from Hospital Administration Risk Reduction Programme for the Elderly
(HARRPE) list. Pharmacists would provide personal interview, medication reconciliation and try to tailor-made a drug regimen
that the patients are committed to comply. After discharge, ICDS nurses would visit the patients to provide educational
interventions to enhance patient’s autonomy and involvement in their care and treatment.

It is a win-win process. On the one hand, we can reduce poly-pharmacy and enhance patient outcomes. On the other hand,
patient empowerment on drug concordance is also achieved. To a large extent, older adults can take more responsibilities
on the decision-making of their treatments as well as daily medication adherence in partnership with multidisciplinary care
team.

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