Page 144 - Hospital Authority Convention 2018

Symposiums Symposiums
HOSPITAL AUTHORITY CONVENTION 2018

S4.1 Advanced Care Planning and Elderly Services 09:00 Convention Hall B

Advanced Care Planning in the UK
Finlay of LIandaff I
House of Lords, UK
The UK has been rated first in the world in the Quality of Death index from the Economist’s Health unit (supported by the Ling
Foundation). Although the UK was the founding home of the modern hospice movement, yet there is more to be done in the
UK to ensure that patients and their families have a dignified, comfortable, fulfilling time as life draws to a close.

Many major life-threatening illness follow a somewhat relapsing and remitting pathway, often leaving the patient depleted of
energy after each relapse. Take the cancer patient who undergoes chemotherapy and or radiotherapy. Such treatments can
feel punishing, resulting in fatigue and an inability to work. When the situation is palliative, a major challenge for families is
how best to provide long term care during the weeks and months before the final phase of an illness.

For the patient, fears about their future can be magnified by the difficulties of adapting to living with uncertainty. Advance
care planning rests on the legal frameworks in the Mental Capacity Act of ‘Advance Statements of Wishes’ and ‘Advance
Decisions to Refuse Treatment’. But many patients are reluctant to openly plan their final phase, changing their minds about
their care preferences as unexpected events that arise.
The costs of social care can erode capital funds and continuity of care becomes increasingly important as a person becomes
frailer. If support is inadequate the full burden falls on families.
initiatives in the UK include volunteers becoming increasingly important part of an informal support networks, through
schemes such as ‘Compassionate Communities’ and ‘Help Force’ in hospitals, yet the greater number of people involved, the
more crucial good information transfer becomes between all collaborators.

S4.2 Advanced Care Planning and Elderly Services 09:00 Convention Hall B

Achievements and Challenges in Elderly Service Development in Hong Kong
Mok FCK
Tuesday, 8 May 2018 and social welfare system.
Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong
Hong Kong is facing the full impact of “Silver Hair” boom in the coming two decades with the biggest hit on the healthcare

Infrastructure building and service development for elderly care were high priorities of Hospital Authority (HA). Along the
patient care pathway, there were: (1) Geriatrics support to Accident and Emergency Departments (pilots); (2) Inpatient care
initiatives (10 Acute Care for the Elderly Patients) identification, liaison nursing, Comprehensive Geriatric Assessment pilots,
inter-departmental collaboration, e.g. orthogeriatrics, frail elders pre-operative assessment; (3) Discharge planning and
post-discharge support (Geriatric Day Hospital, Integrated Discharge Support Programme for Elderly Patients, Integrated
Care Model for High Risk Elders, Medical-social Collaboration); (4) Outreaching and Community care (Community Geriatric
Assessment Service (CGAS) + End-of-life (EOL) care, Dementia Community Support Scheme, Community Health Call Centre,
Community Nursing Service); and (5) Patient empowerment (Smart patient website, Patient Discharge Information Summary,
drug refill programme).

However, we have to increase our pace to move on because the older population expansion would soon outgrow (or has
outgrown) our service capacity. The key direction is the collaboration with other partners like Social Welfare Department (e.g.
enhanced CGAS, social infirmary, satellite health centres), Department of Health (elderly health centres/Residential Care
Home for the Elderly (RCHE)/public education), private sectors/public-private partnership (e.g. doctors, RCHE transitional
care places, pharmacy/drug delivery), Legal (EOL care at home/RCHE). Interdisciplinary collaboration within HA is crucial e.g.
nursing, pharmacy, allied health and probably traditional Chinese medicine in the future. The challenge is about how to break
the boundaries between institutions and disciplines and develop workable collaborative models.
Manpower development is also important. Besides the need to maintain a sizable pool of specialised professionals in elderly
care, spreading of geriatric knowledge and skill to all clinicians and healthcare professionals in general is needed. The
challenge is how to deliver these effectively and systematically.
Technological and IT development is rapidly changing the facets of clinical care. Our elders are more educated than before.
The need to adopt geron-technological development and big data information into clinical care is imminent, e.g. e-health
142 programmes, personalised medicine including frailty measures and functional profiles etc.