Community Collaboration Towards Bone Health Wong Hsiao Wah (Christina) Registered Nurse (O&T), Prince of Wales Hospital,Hong Kong
Literature Review Osteoporosis: attract less attention (lower mortality rate) : ever-increasing aging population worldwide : 2 nd leading health care problem (WHO, 2004) Osteoporotic fragility fracture: related to fall (elderly) : mobility, mobidity, psychological impact, quality of life and mortality (Personal) : economic burden (Socio-economical) Recovery: > 1 year for rehabilitation restore functional ability & independence (Sze, 2005) Limited Follow-up Services: short period (3-6 months)?comprehensive information & services in bone health: available : accessible
Background Hip fracture : 4 th leading cause hospitalization (Elderly, Hong Kong) Hip fracture caused by fall: > 90% Past 20 years, hip fracture cases increased persistently Mortality rate (1 st year after injury ): 20% Long-term bed bound: 35% Decrease activity of daily living: 50% Fall preventive interventions reduce fracture: 30% (Ho, 2005)
Comprehensive Fragility Fracture Rehabilitation Program (2008)
Intersectoral Collaboration
Multi-discipinary Approach Orthopaedic Surgeons Orthopaedic Nurses Occupational Therapists Physiotherapists Social Workers General Practitioners
Mission: Mediate with health and non-health sectors to advocate healthy bone message and fall prevention strategies; enable elderly, their caregivers and public to participate and access the skills and services in order to empower to gain greater control their healthy bone lives. (WHO, 1986)
Objectives: 1) Increase public awareness in bone health 2) Provide relevant information 3) Promote dietary, home exercises advices and vibration therapy 4) Educate fall prevention and home safety 5) Facilitate participation in community activities empower physical, psychological and social strength
Logistics Female, aged > 65 Hip Fracture Operation Conservative treatment Rehabilitation Hospital Home ( 6 weeks) Orthopaedic Follow-up + BMD Test Community Health and Fall & Fracture Prevention Program
Community Health and Fall & Fracture Prevention Program Group Exercises (P.T.) Vibration therapy Home Hazard Assessment and Modification(O.T.) Fall and Fracture Prevention & Bone Health Educational Talks (O&T Nurses) Bone Health Consultation (G.P.)
Vibration Therapy It is a safe and non-invasive procedure that trainer step both foot on a vertically vibration platform in a standing position for period of time. Advantages :increasing muscle power, :improve muscle coordination, :increase muscle strength :prevent osteoporosis :reduce fall risk. (Torvinen et al., 2002) Vibration Therapy platform
Feedback Venue: Easy to access : Close to home, save time and transportation fee Environment: Warm, : Sincere and helpful (nurses, staff, helpers, volunteers) Regular physiotherapy: can improve their mobility status : have fun during group exercises : can meet new friends Vibration therapy: like it very much Summary More active (willing to participate in outdoor activities) Maintain social linkage Peer group support and influence Cheerful and more social
Community Activities for Elderly Focus on Fall Prevention Healthy Bone Educational Talks and Fall Prevention
For Elderly Simple Fall Risk Assessment Conducted by trainers Balance Test BMD-QUS Test Vision Test
For Elderly Assessment & Advice Fall Prevention measures Home Safety Advice Footwear advice
Dietary Advices --rich Calcium diet & food choices --increase bone health tips
Community Activity in Healthy Bone Promotion Women Association Open Days Objectives: Maintain and strength bone quality Activities: Healthy Bone Educational Talks Calcium-rich Dietary Advice and Food Choices Tai Chi Exercise demonstration by trained volunteers BMD Test by QUS (Quantitative Ultrasonography) BMD analysis & Bone Health Advice by Orthopaedic nurses
For women---dietary consumption to bone health (Rich-calcium food choice)
Limitation : Resources : Manpower : Related Professional training & Clinical Practices Ways Forwards: Extended Services (district & age group)
Conclusion: Building healthy bones earlier, = prevent osteoporosis and fracture in later in life : Intersectoral collaboration (health and non-health sectors) : Healthy bone knowledge and skills individual and family community and younger population. (like generation tree) : Active lifestyle with bone health promote
Acknowledgment Professor K.S Leung Orthopaedic and Traumatology Department, Prince of Wales Hospital Mr. Tong Fong (D.O.M.) Orthopaedic and Traumatology Department, Prince of Wales Hospital Ms. Jessica, Chan T (N.S.) Orthopaedic and Traumatology Department, Prince of Wales Hospital
Acknowledgment Group members Wong Hsiao Wah Au Chung Yan Chun Choi Ying Mak Wai Ping Yu Wai Sum
References Ho, S. C., Chen, Y. M. & Woo, J. L. F. (2005). Educational level and osteoporosis risk in postmenopausal Chinese women. American Journal of Epidemiology, 161,680-690. Hui,Y. (2002). Osteoporosis: should there be a screening programme in Hong Kong? Hong Kong Medical Journal, 8 (4), 270-277. Sze, P.C.et.al.(2005). A primary prevention programme for older people in Hong Kong. British Journal Community Nursing, 10, 166-171. Torvinen, S., Kannus, P., Sievaneb, H., Jarvinen, T. A. H., Pasanen, M., Kontulainen, S., Javinen, T. L. N., Jarvinen, M., Oja, P. & Vuori, L. (2002). Effect of a vibration exposure on muscular performance and body balance. Randomized cross-over study. Clinical Physiology and Functional Imaging, 22 (2), 145-152. Watts, N.B. (2002). Bone quality: Getting closer to a definition. Journal of Bone Mineral Research, 17,1148. World Health Organization. (1986). Ottawa charter for Health promotion: an international conference on Health promotion. Denmark: WHO World Health Organization. (1994). Assessment of fracture risk and its application to screening for post-menopausal women. Geneva, Switzerland: World Health Organization. World Health Organization (2004). Expert committees and study group: Prevention and management of osteoporosis. WHO Technical Report Series, 921.
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