Page 90 - HA Convention 2015

Special Topics

ST2.4 Nursing — Rehabilitation and Elderly Services 13:15 Theatre 1

Monday, 18 May End-of-life Care for Elderly at Old Age Home
Leung LS
Medicine Community Geriatric Assessment Team, Queen Elizabeth Hospital, Hong Kong

Residents in Residential Care Home for the Elderly (RCHE) tend to have multiple co-morbidities and irreversible chronic
diseases. With the downhill course of the chronic illness anticipated, resuscitations of this group of frail elderly are commonly
futile and add extra suffering to them as well as the family members. Therefore, it is worth to promote and provide end-of-life
care to this group of frail elderly.

End-of-life care is defined as an active, compassionate approach that treats, comforts, and supports persons who are living
with, or dying from progressive chronic life threatening conditions. To provide a quality end-of-life care services to residents
of RCHE, the Community Geriatric Assessment Team (CGAT) of Queen Elizabeth Hospital launched a pilot programme
“The End-of-Life Care Programme for Elderly Home Patients” in 2010 with collaboration with other healthcare workers in
the accident and emergency department, hospital wards, and the staff of RCHE. The target patients of the programme
are residents suffering from advanced dementia and other chronic illnesses. The CGAT nurse initiated the Advance Care
Planning (ACP) discussion with the patients and the family members with documentation to facilitate caring decision to avoid
unnecessary investigation or resuscitation that will add sufferings to the residents. The programme aims at reducing physical
symptoms and providing comfort care, psycho-social support to the elderly and the family members. To further enrich the
quality of life of this group of patients, we engaged volunteers’ participation since October 2012, and 28 volunteers were
recruited. We reviewed the service by obtaining feedback from volunteers and RCHE staff. 100% strongly agreed or agreed
that this programme was effective in managing service needs, enhancing quality of care, maintaining continuity of care and
ultimately improving the quality of life with respect to the patients’ own choice. The patients and families were grateful that
they were supported and accompanied to walk through the final stage of their lives.

ST2.5 Nursing — Rehabilitation and Elderly Services 13:15 Theatre 1

Lifestyle Management Programme for Stroke Patients through Patient Empowerment
Kwong JCL
Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong

IntroductionHOSPITAL AUTHORITY CONVENTION 2015

Stroke is one of the leading causes of morbidity in Hong Kong, causing significant physical and cognitive impairment in many
stroke survivors. Risk of recurrent stroke is significantly high. Nurse-led programme through patient empowerment in lifestyle
changes, caregiver support, stroke risk reduction behaviour; medications monitoring and complication screening, i.e. Trans-
cranial and carotid Doppler can reduce the chance of recurrent stroke. Patient empowerment can boost up their confidence
and self-esteem with better quality of life and control.

Objective

(1) To facilitate patients’ engagement and empowerment in lifestyle management that cultivating positivity and goal oriented
life as to improve the quality of life of stroke survivors; and (2) to reinforce compliance in stroke risk reduction lifestyle
behaviour through continuous nursing interventions and group dynamic.

Methodology

A pilot project is developed with a comprehensive healthcare plan for stroke survivors in order to minimise the risk of
recurrent stroke. Six patients were recruited after their discharge from Stroke Unit of Caritas Medical Centre with their
consent for participation. 10 group meetings with two self-arranged outings in three months were conducted. These
meetings started with patient participative goal setting in lifestyle management, behavioural modifications, occupational
exercises, risk reduction education and monitoring. Four graduated from the programme with two defaulters.

Conclusion and Recommendations

All four graduates have achieved their planned goals with better confidence to return to their social life and one found a new
job after this programme. Nurse-driven programme not only provides patient education, support for stroke patients through
patient empowerment and lifestyle redesign, also provides continuity of patient assessments, monitoring and complication
screening throughout the programme. That would improve their quality of life, prevention of recurrent stroke and reduction
in related complications. Nurse-driven lifetyle management programme has a significant impact on prevention of secondary
stroke and reducing complication. Patients are empowered to return to their community and social life with better quality of
life. Due to the intensity of group dynamics, the preferable group size would be 10 in total with patients and carers. Social
outings are most welcomed by the participants that facilitate their return to the community.

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