End-of-Life Care Program for Elderly Home Patients Team work and Volunteers engagement Division of Geriatrics, Department of Medicine Queen Elizabeth Hospital, KCC LEUNG LS, LAM WM, NG LY, MAK YF, TAM KF Stanley, CHAN SF Ryan LIU YW Eva
The Aging Population in Hong Kong One in three people in the city is expected to be 65 years old or above by 2041
Year Life Expectancy for Males Life expectancy for Females 2009 79.8 85.9 2010 80.1 86.0 2011 80.3 86.7 2012 80.7 86.4 2013 80.9 86.6 Census and Statistics Department Website: http://www.censtatd.gov.hkhong Kong Special Administrative Region Government June 2014
Resulting in a High Institutionalization Rate City/ Country Institutionalization Rate of Population Aged 60 or Above HK 6.8% (2009) Japan 3.0% (2006) Singapore 2.3% (2006) Taiwan 2.0% (2009) Australia 5.4% (2006) UK 4.2% (2004) USA 3.9% (2004)
The Aging Population in Hong Kong and over 90% of those living in elderly homes suffered from one or more chronic diseases (Census and Statistics Department HKSAR, 2009)
Elderly Home patients services need in Kowloon Central Cluster (KCC) They accounted for: one quarter of all QEH MED admission one third of all mortality in our KCC cluster
Significant increase in hospital services need in last few months of life OAH patients, HA data 2013 6 months 3 months 1 month
Resuscitation of frail OAH patients Among resuscitation records of OAH patients (in 2007) 31% responded to initial resuscitation But finally succumbed (within hours - days) initial successful not successful not successful
What did patients get?
What did patients get?
What did patients get?
What did patients get?
What did patients get?
The HA s Vision and Mission for its elderly patient services are: Vision: To enhance the well-being of elderly people, and to contribute to healthy ageing, by raising the standards and quality of healthcare wherever care is given. Mission: To offer seamless and high-quality care in primary, community and hospital settings in order for elderly patients to receive services appropriate to their needs. And Advocate and promote better care standards for elderly patients in non HA settings, including RCHE Hospital Authority Strategic Service Framework for Elderly Patients 2012
End-of-life Care Program for Elderly Home patients
The program content Comfort care & symptoms control Psychosocialspiritual care Family engagement Patients Care after death Coordination of care Volunteers engagement
Action End-of-life Care Program for Elderly Home patients Initiate the Advance Care Planning discussion with patients and family members Detail discussion of disease and treatment options to avoid invasive and unnecessary investigations and procedures
Action End-of-life Care Program for Elderly Home patients 2. Care for the patients: Comfort Care Symptom control: pain, pressure ulcers care, swallowing & nutrition, etc Regular visits and review of patients especially when condition changed
Action End-of-life Care Program for Elderly Home patients 3. And psycho-socialspiritual support to the patients and family members
End-of-life Care Program for Elderly Home patients Action 4. Educate and liaison with Elderly homes to gain their supports
End-of-life Care Program for Elderly Home patients Action 5. Continuity of care from hospital, after discharge (at OAH) and upon deceased
End-of-life Care Program for Elderly Home patients
End-of-life Care Program for Elderly Home patients
Results: N=334 (Aug/2010-Aug/2014) Demographic Data: - Average Age: 88 - Female: 238 (71%) Male: 96 (29%) Functional Status: - Barthel score 0-1/20 =279 (84%) - Barthel score 2-12/20 = 55 (16%) Disease group: - Dementia/CVA: 260 (78%) - Cancer: 14 (4%) - Others: 60 (18%) On NG tube feeding: 231 (70%)
Results: Aug 2010 to Aug 2014 : served 334 OAH clients passed away n=222 96.8% no intubation/cpr done with respect to the patients wish passed away n=227 Average months under EOL program: 6.35 months
To further enrich and enhance their Quality of Life..
Volunteer Engagement Program 寧護達人 義工計劃 Aim To Enrich the End-of-Life care service to our patients and their family members through physical care, psychosocial support by volunteers in order to enhance their Quality of Life.
Program Content Program started at Oct 12 2 Classes (Oct 12 and Nov 13) with 28 volunteers recruited through interviews
Program Content 16 hours training Support by CGAT nurse Volunteers engagement Conduct visit in pairs Regular sharing and review Patients and family members
Volunteer Engagement Program 寧護達人 義工計劃 16 hours Training and regular update of knowledge
Volunteer Engagement Program 寧護達人 義工計劃 Role Play and games to stimulate learning
Volunteer Engagement Program 寧護達人 義工計劃 Visit Elderly homes with supports by Nurses
Volunteer Engagement Program 寧護達人 義工計劃 Regular Sharing
Volunteer Engagement Program 寧護達人 義工計劃 Happy Team work
Evaluations from Volunteers Understand caring need of EOL This service Enhance QoL Strongly Agree (N=5)45% Agree (N=6)55% Neutral (N=3)27% Agree (N=3)27% Strongly Agree (N=5)45% N = 11
Words from Volunteers
Evaluations from OAH staffs Understand caring need of EOL Strongly (N=3)Agree 25% Agree (N=9)75% This service Enhance QoL Strongly (N=3)Agree 25% Agree (N=9)75% N = 12
Words from OAH staffs
Words from Family Member
Conclusion End-of-life Care Program for Elderly Home patients : Enhance Quality of Life Respect patient s Choice Support Family Members Reduce Futile resuscitation and intubation Volunteers engagement Makes it even better
Our Team members and Our important partners
And our most cherish elderlies.
The Happy Couple and the precious moment Their 50 years wedding anniversary Golden wedding
Words from the elderly.
Thank You!
Acknowledgement Dr YF Mak ( KCC Consultant Geriatrics), Dr KF Tam (QEH Hon AC Med & BH AC Med) Ms Eva Liu (KCC CGMN & QEH GMN) Ms Cindy Leung & Shirley Yao(QEH Med DOM), Ms Lam Wai Man (QEH CGAT UM) Other core members QEH CGAT Team, QEH Med PC Team, QEH PRC, QEH AED, and all the Volunteers