Annual Report - Bad Request - The Hong Kong Polytechnic University

Annual Report - Bad Request - The Hong Kong Polytechnic University

1 IntroductionAgeingis a global concern.There are about677 million older adults people aged 60 orover globally, accounting for about 10.3% ofthe total population in 2006 (World HealthOrganization, 2006). It is projected that by2025, there will be about 1.2 billion, nearly atwo-fold increase (World Health Organization,2004). By 2015, it is estimated that 41 millionpeople worldwide will die of a chronic diseaseeach year if the strategies for preventing chronicdiseases remain unchanged (World HealthOrganization, 2005). Tremendous collaborativeeffort from experts of different disciplines willbe required to improve the ageing process andsolve issues arising from ageing (World HealthOrganization, 2002).Hong Kong is no stranger to this global ageingtrend and its impact. In 2007, there were 871,400older adults in Hong Kong, which represented12.6% of the total population (Census andStatistics Department, 2008). If current birth,death and survival trends continue, by 2030,1 person in 4 will be aged 60 or over. A localsurvey reported that 71.6% of older adults weresuffering from chronic diseases (Census andStatistics Department, 2005). Among them,28.3% had only one type of chronic disease,21.0% had two, 11% had 4 or even more,while 58.1% needed chronic pharmaceuticaltreatment. This places immense demands onolder adult care this need, a mobile integrative healthcaremodel was developed in Hong Kong, and itsservice was launched in January 2008.1.1 Topics in this reportThis annual report will describe the backgroundfor setting up the PolyU-Henry G. Leong MobileIntegrative Health Centre (MIHC), the serviceutilization, our clients’ general health, capacitybuilding and a SWOT analysis.1.2 Rounding of figuresOwing to rounding, there may be a slightdiscrepancy between the sum of individualitems and the totals shown in the tables. Itshould also be noted that the actual figureswithout rounding were used to compile thepercentage shares in the tables. Missing datarefers to questions that were not answered bythe clients. Clients had the right to refuse toanswer any questions, and all health data werecollected on a voluntary basis.Experts have been calling worldwide fornew strategies in older adult health servicesprovision because the current service modeldoes not meet current needs and demands, interms of both volume and quality of service. To1

2 Monthly MilestonesMonthlymilestones help the Team toorganize our activities and theavailable resources in achieving the mission of MIHC. Thefollowing provides a narrative account of the milestonesachieved.2.1 January 2008The MIHC launched its service on 16 January 2008. A large-scalecommunity diagnosis (n>500) was conducted at two servicelocations namely Kowloon Bay (Kai Yip Estate) and Sham ShuiPo (Fu Cheong Estate). Community diagnosis was carried outin order to obtain a baseline for health profiling of communitiesto be served, to identify their health problems and to prioritisehealth education/intervention needs.Client receiving Bowen therapy2.2 February 2008Community diagnosis was completed and health needs in theservice regions were identified. Case conferences were held todiscuss the community profile and the older adults who havecontributed to the profile. Follow-up and integrative therapieswere prescribed to them after case conferences.Counselling session provided by APSSmaster student in the MIHC2.3 March 2008We identified a great demand for service in providingpsychosocial support to clients at risk of developing depression.To meet this demand, MIHC coordinated with the Departmentof Applied Social Sciences (APSS) for Masters’ degree studentsexperienced in family therapy to serve in the MIHC, as part oftheir clinical service requirements. The Advanced PracticeNurses of the MIHC coached the students in interviewing clientsand providing psychosocial support. Thus, clients as well as theMIHC and APSS students benefited.APN students from the Yale Universitylearning how to use self-assisted healthassessment Kiosk2

22.4 April 2008MIHC added a new venue, Lai King, to its service route.Oral and dental health assessment was introduced as a newservice to the clients as poor dental health may be a primarycause for poor nutrition among older people.2.5 May 2008The MIHC team attended the First NUS-UH Conference:Advanced Practice Nursing in Multicultural Environments inSingapore where there were international nursing scholars andpractitioners from 11 countries. The MIHC team made five oralpresentations. The experience of advanced nursing practice inprimary care was presented.Visual acuity assessment in MIHCSeven Advanced Practice Nurse (APN) students from YaleUniversity conducted 3 days’ academic visit in the MIHC. Thislaid the foundation for experience-sharing among advancedpractice nurses from different cultural backgrounds.Pain was acknowledged as one of the major health problemsamong the MIHC clients. A pain management internshipprogramme was conducted in order to train nursing studentswho work with clients with pain. Through demonstration andpractice, APNs provided the students with a more comprehensiveunderstanding of a multidimensional approach in painmanagement. In addition to current consultation sessions, theMIHC provided Bowen therapy for clients with musculoskeletalpain.Photo taken during academic visit byProfessor Isabel Amélia Costa Mendes(Director of the WHOCC)(right 3)2.6 June 2008A pilot clinical study on non-invasive blood glucose monitoringwas carried out in Lai King District, and 48 MIHC clients and theircare-givers participated in the study.31st NUS-UH Conference

22.7 July 2008The accreditation panel from the Hong Kong Nursing Council visited the MIHC. The MIHC hasbeen recognized as an accredited venue for registered nurse training in Hong Kong.A study on the relationship between 6-sulphatoxymelatonin (aMT6s) level and sleep, led by Dr.Jacqueline Ho, Assistant Professor of the School of Nursing, was started.2.8 August 2008Two exchange students from the University of Texas had their clinical placement in the MIHC.Throughout their placement, they were introduced to many unconventional therapies like Bowentherapy and the bodyblade programme for treating chronic musculoskeletal pain.In view of the poor nutritional condition identified among some MIHC clients, a nutritionimprovement campaign was held to teach MIHC clients ‘eat-wise’, i.e. choice of food purchasingand how to promote body resistance by wise choice of food intake.The first system revamp of the telehealth interface was conducted. To improve our service qualityand assure data quality, the team conducted a thorough system review and implemented thenecessary system changes. This enhances the stability of the telehealth system.2.9 September 2008Visual acuity assessment was launched in the MIHC. Referrals were made for clients with poorvision.2.10 October 2008Director of the WHOCC, Professor Isabel Amélia Costa Mendes, and her colleague visited the MIHCin order to gain a deeper understanding of the novel model of primary care delivery through“moving the service to the needy”.4

22.11 November 2008To arouse public awareness of health promotion andto introduce the public with our new health care model, weparticipated in the Science in Public Service Fun Fair in VictoriaPark. Free on-site health checks were provided.The MIHC team participated in a 30-minute performance tointroduce the public to the bodyblade exercise programmedelivered by the MIHC. We continually strive to arouse publicinterest in adopting a healthy lifestyle that includes moreexercise and fewer sedentary habits.Bodyblade exercise programme in theScience in Public Service Fun Fair inNovember 20082.12 December 2008To meet the high service demand in Kowloon Bay, The HongKong Society for The Aged (SAGE) has generously let us use theiractivity room for our service every Thursday. A mini-station wasset up in Kowloon Bay.The guests tried MIHC and free healthchecks provided in the opening ceremonyof the CHEERS programmewereTo arouse public interest in the health issues of mentallyhandicapped older persons, the MIHC team participated in theopening ceremony of the CHEERS programme funded by theQueen Elizabeth Foundation for the Mentally Handicapped.Tours of the MIHC and free health checks were provided.The second system revamp was carried out in December 2008.A new interface was introduced in order to provide a more userfriendlyinterface for self-assisted health assessment and toenhance stability in data retrieval.MIHC team participated in the openingceremony of the CHEERS programme inDecember 20085

3 BackgroundThePolyU-Henry G. Leong Mobile Integrative HealthCentre (MIHC) was established through a grantof HK$8.2 million from philanthropist Mr. Edwin S.H. Leong toThe Hong Kong Polytechnic University (PolyU) for the purposeof providing free health screening and monitoring services toelder people in Hong Kong.Built upon the foundation of the Telehealth System and ourintegrative health clinics / centre, the MIHC was inauguratedon 18 December 2007. Its services integrate Western medicine,cutting-edge technology and traditional Chinese medicineto promote, prevent and maintain health. The MIHC aims toestablish a rapport with senior citizens by attracting them to jointhe health screening service and different kinds of integrativetherapies, which enable older adults residents in need to attaina healthy lifestyle. In this way, their daily lives are enjoyableand fruitful as a result of achieving harmony and equilibriumof body, mind and soul. MIHC particularly hopes to reach thehidden elderly who may have no family and few friends. Throughcollaboration and outreach work with the local District ElderlyCommunity Centres and Neighbourhood Elderly Centres, thesehidden senior citizens can be drawn into their local communitythrough personal assistance, counselling and support services.MIHC Inauguration Ceremony on 18December 2007MIHC client has her first trail in usingthe state-of-the-art equipment of theCentre3.1 Description of the MIHCThis Centre operates in a vehicle (11m long, 2.5m wide and 4mhigh). It visits various areas in Hong Kong on weekly basis toprovide easily accessible health check and monitoring servicesto senior citizens. Its vision is to maintain the health and qualityof life of the elderly, and ultimately to ease the burden on thecommunity for their medical and healthcare costs. The MIHC isstaffed by professionals, including Advanced Practice Nurses,registered nurses, traditional Chinese medicine practitionersand nutritionists, information technology staff and engineers,and it is equipped with advanced health check equipmentMIHC client’s exercise class6

3such as heart rate variability meters and wheelchair elevators.Records are kept with the award-winning “Telehealth” systemdeveloped by PolyU. This is a database that can maintain lifelongpersonal and family-based health profiles. It can also beused to map out the health profile of our community, and will beinstrumental in developing healthcare professional training andservices that can meet the needs of our community in comingdecades. Telehealth also includes a tele-mode that can connectexperts at remote locations with clients whenever needed.MIHC consultation session3.2 MIHC in operationTo be registered in our system, all clients registered undergoa comprehensive health assessment. The assessment has twolevels. The first level focuses on general health status: assessinghow happy our clients are (Happiness test), reviewing whatkind of activities they prefer (Activities preference assessment),analysing how independent their lifestyle is (Life 12), screeningfor under-nutrition (Mini-nutrition Assessment), assessing theirpain problems (Brief Pain Inventory), assessing their cognitivestatus (Abbreviated Mental Test) and measuring their vital signs.This level mainly serves as screening for conditions that requireimmediate/emergency actions or referrals.MIHC clients collected ingredient afternutrition talkMIHC community diagnosis MIHC case conference MIHC pain consultation7

3After case conference with all specialists such as pain management experts, nutritionists,traditional Chinese medicine practitioner, etc, to determine a client’s specific needs, the MIHCteam will determine further assessment and/or suggest specific activities/therapies whichwould be most beneficial. Secondary assessment includes assessing whether they are depressed(Geriatric Depression Scale), whether their movement ability is impaired (Elderly Mobility Scale),nutritional status and dental condition, as well as any impaired cognitive status (Mini Mental StateExamination). In addition, the Centre will give professional advice and guidance on healthy eatingand taking exercise, and arrange training and education as needed. Videos are also displayed onthe vehicle’s exterior to promote health messages to the community. Figure 1 shows our clients’pathway after they register for our service.RegistrationGeneral Health Assessment1 Happiness test2 Activities preference assessment3 Activities of Living screening4 Oral Hygiene screening5 Nutrition screening6 Pain assessment7 Brief mental test8 Visual Acuity screening9 Bio-measurementActivities1 Positive & well-being preservationTai Chi, mind cultivation,Haptics therapy2 Psychological healthRelaxation exercise, counselling3 Fitness gamesFoot massage path, memoryand cognitive video games4 Exercise programmeMuscle strengthening exercise5 Dietary modification6 Health education7 Pain managementBowen therapy, aromatherapy,massageand othersCaseConferenceFocus AssessmentEvaluationService CompletedReferralFigure 1: Algorithm of service provided8

4 Service UtilizationDataon service utilization provide us a continuum of information regarding theacceptance of the MIHC, service demand, applicability and limitations. Serviceutilization is reflected by the attendance, frequency of visits, number of intervention sessions andnumber of referrals made by MIHC nursing staff.4.1 Attendance in the MIHCThe MIHC serves three districts and became four in late April. With reference to HK populationstatistics, we approached SAGE for service in Kowloon Bay and Sik Sik Yuen for Sham Shui Po.In March, the District Councillor of the Kwai Tsing District Council contacted us for service. InDecember, we started to have a mini-station in Kowloon Bay. Table 1 shows the service scheduleof the MIHC.Table 1: Service schedule of the MIHCMonday Tuesday Wednesday Thursday FridayServicecommencementLai KingKowloonBaySham ShuiPoKowloon BaySham ShuiPoApril 08 January 08 January 08 January 08 January 08Service hour 9am-5pm 9am-5pm 9am-5pm 9am-5pm 9am-5pmMini-station December 09Service hour9am-5pm9

4The total attendance during the period of reporting (16 January to 31 December 2008) was 4,323.Table 2 shows the breakdown of attendance in the three districts. Reasons for non-attendanceinclude scheduling conflicts, sickness or bad weather.Table 2: Number of attendance by districts (N=1057)Kowloon Bay(n=459)Sham Shui Po(n=370)Lai King(n=228)n (%) n (%) n (%)Number of attendance 1971 (92.2) 1503 (91.5) 849 (85.7)Number of nonattendances*166 (7.8) 139 (9.5) 142 (14.3)* non-attendance—those who have booked appointments but do not show upFigure 2 shows MIHC attendance by month and shows seasonal variation. Services in summerwere mostly affected. The services were suspended because of hot weather, rain and typhoon.(Table 3)Figure 2: Number of clients attending MIHC by month10

4Table 3: Reason for service suspensionDateReasons18 April 08 Typhoon Neoguri26-30 May 08 Routine maintenance23 June 08 Very Hot Weather Warning24-25 June 08 Typhoon Fengshen7 July 08 Emergency repair of generator10 July 08 Amber Rainstorm22 July 08 Very Hot Weather Warning28 July 08 Very Hot Weather Warning4-6 August 08 Typhoon Kammuri19-22 August 08 Typhoon Kammuri25-29 August 08 Yearly vehicle checkup16 September 08 Very Hot Weather Warning18 September 08 Very Hot Weather Warning23-24 September 08 Typhoon Hagupit3 October 08 Typhoon Higos23 December 08 Cold Weather Warning Signal4.2 Frequency of visitsTable 4 shows the frequency of visits in various locations. Percentage of service utilization inKowloon Bay and Sham Shui Po districts were similar. The differences noticed in the Lai Kingdistrict may be because (1) only one service day was available in that region; and (2) the servicewas launched in April. There were a higher percentage of clients who visited the MIHC 2-4 timeswhich may indicate that older people were likely to attend health screening every 3 to 6 months.Clients who attended MIHC service 8 times or more were mainly clients who required protocoldriventherapies.Table 4: Frequency of visits by clients (N=1057)Kowloon Bay(n=459)Sham Shui Po(n=370)Lai King(n=228)Frequency of visitsn (%) n (%) n (%)1 55 (12.0) 40 (10.8) 83 (36.4)2-4 267 (58.2) 245 (66.2) 75 (32.9)5-7 80 (17.4) 37 (10.0) 38 (19.0)>8 57 (12.4) 48 (13.0) 32 (14.0)Total number of visits 1971 1503 849Grand Total 432311

44.3 Source of clientsCommunity partners like District Older Adults Community Centres, the Neighbour Older AdultsCentre, Community Nurses and District Councillors were the main source of referrals to the MIHC.For instance, the majority of clients in the Lai King district (99.6%) were referred by them. In contrastwith both Kowloon Bay and Lai King, only about one-third of the clients in Sham Shui Po districtwere referred by community partners (Figure 3). In Sham Shui Po, the majority of the clients (40%)were attracted by other sources, e.g. press or radio interview, or were referred by friends or familymembers.Figure 3: Distribution of referral sources of clients attending MIHC12

44.4 Focus assessment and interventionsStarting from April 2008, a number of focus assessment and intervention sessions were carriedout targeting health problems like diabetes mellitus, pain, psychosocial problems, obesity, andpoor balance. Breakdown of the attendance in focus assessment and interventions is shown inFigure 4.Focus assessment and interventions in MIHCNumber of clients1009080706050403020100Apr' 08 May' 08 Jun' 08 Jul' 08 Aug' 08 Sep' 08 Oct' 08 Nov' 08 Dec' 08DMPainCounsellingExerciseMonthFigure 4: Number of clients attending MIHC focus assessment and interventions13

44.5 ReferralsAfter the nursing assessment, urgent/non-urgent referrals (e.g. for ambulance, medical outpatientservices and social counseling) were made as indicated. Table 5 shows the reasons and frequencyof referrals.Table 5: Reasons and frequency of the referralsProblem identifiedNumber of referrals madeHigh blood pressure problems / fluctuating blood pressure 147High blood glucose / uncontrolled diabetes 81Psychosocial 54Arrhythmia with cardiac symptoms 27Pain 18Visual problems 12Respiratory problems 8Severe weight loss (>10lbs in one month) 8Memory problem 5Wound 4Chest pain 2Gastro-intestinal problems 2Varicose veins 2Others 21Total 39114

5 Health ProfileToundertake a health needs assessment, it is critical to know and understand the olderadults being served and the health issues they face. To this end, a broad spectrum ofdata, representing a multidimensional health status, is collected to evaluate the individual andcommunity health profile.5.1 Demographics5.1.1 GenderA total of 1,057 older people received MIHC services between 16 January and 31 December 2008.Most--43.4%-- clients came from Kowloon Bay, followed by Sham Shui Po (35%) and Lai King(21.6%). Similar to the Hong Kong population (female, 52.3%; 47.7% male), the proportion offemale clients was higher than that of male clients. The percentage of females among the olderpersons in the general population in these three service locations ranged from 57.8 to 71.5. (Censusand Statistics Department, 2007)5.1.2 AgeThe mean age (SD) was 75.7 (7.6) years old, with around two-thirds (65.2%) being female. Again,this is comparable to that of the general population of older adults in HK (Table 6).Table 6: Distribution of gender and mean age by gender by district (N=1057)Location of serviceKowloon Bay(n=459)Sham Shui Po(n=370)Lai King(n=228)GenderMean age(SD)n (%) n (%) n (%)Male 144 (31.4) 156 (42.2) 65 (28.5)Female 315 (68.6) 214 (57.8) 163 (71.5)Male 75.2 (9.5) 73.2 (10.3) 72.1 (6.8)Female 76.5 (9.5) 72.5 (9.5) 73.0 (8.0)Overall 76.1 (9.4) 72.8 (9.8) 72.8 (7.7)15

55.1.3 Marital statusOn average, 52.1% of the older persons were married and 31.7% of them were widowed (Figure6). As reported by the government in 2006, 31.9% of older persons in Hong Kong were widowed(Census and Statistics Department, n.d.) A higher percentage of females were widowed thanmales.Figure 5: Distribution of marital status of clients attending MIHC (N=446)16

55.1.4 Social participationApproximately 13.5% of our clients were unengaged (hidden) older persons (Table 7). The figure isslightly higher than the reported figure which was 10.6% (Fung,2008, January 21). The percentageof unengaged older persons was highest in the Kowloon Bay district. It is noted that the discrepancymay be due to the network of the local community partners.Table 7: Extent of participation in society among older persons (N=989)Kowloon Bay Sham Shui Po Lai KingParticipation in(n=430) (n=331) (n=228)societyn (%) n (%) n (%)Unengaged* 125 (29.1) 9 (2.7) 0 (0.0)Partially unengaged* 12 (2.8) 10 (3.0) 1 (0.4)Engaged* 293 (68.1) 312 (94.3) 227 (99.6)* Unengaged=Behaviourally withdrawn from family or community networks for the pastthree months; Partially engaged=Behaviourally increasingly withdrawn from the family orcommunity networks / decrease in the number of connections with social systems for the pastthree months; Engaged=actively participated in social system for the past three months17

55.2 Health historyThe top 5 health problems among the clients were hypertension, painful joints, cataracts,uncontrolled diabetes and hyperlipemia (Table 8). The prevalence of these problems is similar tothat among the elderly in most of the developed countries.Table 8: Distribution of the five most common health problems by gender by district (N=1057)Major healthproblemsKowloon Bay(n=459)Sham Shui Po(n=370)Lai King(n=228)Male Female Male Female Male Femalen (%) n (%) n (%) n (%) n (%) n (%)Hypertension 73 (50.7) 159 (50.5) 58 (37.2) 102 (47.7) 25 (38.5) 90 (55.2)Painful joints* 29 (20.1) 71 (22.5) 23 (14.7) 42 (19.6) 15 (23.1) 41 (25.1)Cataract 33 (22.9) 78 (24.8) 25 (16.0) 43 (20.1) 8 (12.3) 30 (18.4)Diabetesmellitus27 (18.8) 65 (20.6) 29 (18.6) 32 (15.0) 8 (12.3) 21 (12.9)Hyperlipidaemia 13 (9.0) 34 (10.8) 13 (8.3) 31 (14.4) 4 (6.1) 17 (10.4)*include gout, degenerative joints and rheumatic arthritis18

55.2.1 Smoking and drinking habitThe majority of our clients were non-smokers and non-drinkers (Table 9). Only 9.6% of the olderpersons were active s2okers and 12.2% of them were drinkers. There were similar percentages ofmale (8.8%) and female smokers (8.4%). However, as reported by WHO, smoking was most prevalentin the older females (Yang et al., 2008). The overall percentages of binge drinkers in Kowloon Bay,Sham Shui Po and Lai King were 3.2%, 4.8% and 2.2% respectively. Since binge drinking increasesone’s risk for stroke and other cardiovascular problems, the issue deserves attention although theprevalence is lower than that of Western countries.Table 9: Smoking and drinking habit by gender by district (N=993)SmokinghabitHabitKowloon Bay(n=417)Sham Shui Po(n=315)Lai King(n=225)Male Female Male Female Male Femalen (%) n (%) n (%) n (%) n (%) n (%)Smoker 9 (7.1) 21 (7.2) 15 (10.4) 19 (9.2) 8 (12.3) 18 (11.3)Ex-smoker(>6months)12 (9.4) 32 (11.0) 22 (15.3) 39 (18.8) 7 (10.8) 10 (6.3)Non-smoker 106 (83.5) 237 (81.7) 107 (74.3) 149 (72.0) 50 (76.9) 132 (82.5)Drinker 3 (2.4) 2 (0.7) 2 (1.4) 4 (1.9) 1 (1.5) 1 (0.6)DrinkinghabitBinge drinker 6 (4.7) 26 (9.0) 26 (18.1) 22 (10.6) 6 (9.2) 16 (10.0)SocialdrinkerEx-drinker(>6months)0 (0.0) 2 (0.7) 0 (0.0) 0 (0.0) 0 (0.0) 1 (0.6)6 (4.7) 11 (3.8) 7 (4.9) 21 (10.1) 6 (9.2) 6 (3.8)Non-drinker 112 (88.2) 249 (85.9) 109 (75.7) 160 (77.3) 52 (80.0) 136 (85.0)5.3 Socioeconomic characteristics5.3.1 HousingThe majority of the MIHC clients live in public housing, i.e., 74.5%, 77.2% and 96.9% in Kowloon Bay,Sham Shui Po and Lai King respectively. Approximately 20% of MIHC clients in Kowloon Bay live inprivate housing (Figure 6), which was the highest percentage among the three service locations.The majority of our clients were living in flats (91.4%) since most of them were living in publichousing. Different from other locations, in Sham Shui Po, there was a higher percentage of clientsliving in room (9.4%) and ensuite (4.5%).19

5Kowloon BayHousing(n=417)Living with others(n=416, exclude living in nsg home)Relationship with others(n=302, exclude living alone)Shum Shui PoHousing(n=352)Living with others(n=352)Relationship with others(n=186, exclude living alone)20

5Lai KingHousing(n=225)Living with others(n=225)Relationship with others(n=193, exclude living alone)OverallHousing(N=994)Living with others(N=993)Relationship with others(N=681)Figure 6: Distribution of socioeconomic status of clients attending MIHC5.3.2 Clients living with othersMore than 46% of the older people in Sham Shui Po were living alone which was the highestpercentage among the three service locations (Figure 6). According to the Hong Kong MonthlyDigest of Statistics (2008), 30.8% of older persons were either living alone or with other older familymembers only.21

55.3.3 Relationship with othersIn general, for those clients living with other people, the majority described their relationship withthose with whom they lived as good (Figure 6). 6% in the Kowloon Bay district and 4% in bothSham Shui Po and Lai King districts claimed that they had a poor relationship with the people withwhom they lived.5.3.4 Social Security AssistanceAccording to Social Welfare Department (2009), the percentage of Community Social SecurityAssistance (CSSA) recipients aged 60 or over was 38.9%. Approximately 35% of our clients werereceiving CSSA (Table 10).Table 10 : Number of Social Security Assistance recipients by district (N=980)Social security assistance*Kowloon Bay(n=413)Sham Shui Po(n=348)Lai King(n=219)n (%) n (%) n (%)CSSA 146 (35.4) 169 (48.6) 32 (14.6)Disability Allowance (DA) 9 (2.2) 3 (0.9) 2 (0.9)Old Age Allowance (OAA) 123 (29.8) 77 (22.1) 89 (40.6)None 135 (32.7) 99 (28.4) 96 (43.8)*CSSA=Comprehensive Social Security Assistance, DA=Disability allowance, OAA=Old age allowance22

55.4 MobilityOn average, 93.4% of MIHC clients were able to walk independently. Similar figures (96.5%) wereobtained with a mobility test using the Elderly Mobility Scale (Figure 7 and Table11). This indicatesthat the majority of our clients were able to perform activities in daily living independently. Thepercentage of older people who needed help with mobility in the Kowloon Bay (1.8%) was at leastdouble those in Sham Shui Po (0.9%) and Lai King (0.5%).Figure 7: Distribution of mobility status of clients attending MIHC (N=979)23

5Table 11: Elderly Mobility Scale by district (N=911)Kowloon Bay Sham Shui Po Lai KingElderly Mobility Scale(n=389)(n=316)(n=206)(Total=20)n (%) n (%) n (%)

55.6 Depression assessmentAs stated by World Health Organization (2007), it is estimated that at any given time, 5-10% ofthe population is suffering from depression requiring psychiatric treatment or psychosocialintervention. In our sample, 13.7% of older persons had a Geriatric Depression Scale (GDS) score> 8 . Among those with depression, 25% were male and 59.5% were female. These figures wereconsistent with that of WHO’s statistics. (Table 13).Table 13: Depression score by gender by district (N=923)GDS-15 score(Total=15)

55.7 HappinessOur clients were asked to rate their degree of happiness on a validated Subjective Happiness Scaleof 1 (most unhappy) to 7 (most happy) which was developed by Lyubomirsky & Lepper (1999).Over 50% of clients in all districts indicated a degree of happiness higher than the mean scores(Table 14). The mean scores of the happiness assessment were similar in Kowloon Bay (20.8) andSham Shui Po (20.9) districts. A slight difference was identified in the Lai King district (21.4) whichmay indicate that people in Lai King district are marginally happier than people in the other tworegions.Thus, despite problems of pain, mobility, depression, dementia and maintenance of a safeenvironment, clients reported satisfactory levels of happiness as measured by the SubjectiveHappiness Scale.Table 14: Subjective Happiness Score by district (N=975)SubjectiveHappinessScore (Total=28)Kowloon Bay(n=408)Sham Shui Po(n=346)Lai King(n=221)n (%) n (%) n (%)4-7 13 (3.2) 10 (2.9) 5 (2.3)8-14 40 (9.8) 30 (8.7) 16 (7.2)15-21 150 (36.8) 122 (35.3) 72 (32.6)22-28 205 (50.2) 184 (53.2) 128 (57.9)Mean (SD) 20.8 (5.5) 20.9 (5.5) 21.4 (5.0)*Subjective Happiness Scores of 4 and 28 represent the least and most happiness respectively26

55.8 Nutrition5.8.1 Mini nutritional assessment (MNA) – ScreeningThe percentages of older persons with risk of malnutrition (MNA score

55.8.2 Malnutrition indicator score (MIS)Of those 293 MIHC clients who required a further assessment in nutritional status (MNA

55.9 Cognitive assessment5.9.1 Abbreviated mental test (AMT)The majority of our clients had normal cognitive functioning. With a range from 1.9% to 8.3%, 5.2%of them were at risk of abnormal cognitive functioning (AMT

55.9.2 Mini Mental State Examination (MMSE)Of those 49 MIHC clients who required a further assessment, 38 clients were further assessed bythe MMSE as at 31 December 2008. For older persons who had completed further assessmentby the MMSE, only 2% had normal cognitive functioning. However, 10.7% of them, all from theKowloon Bay district, had severe cognitive problems (Table 18). On average, the percentages ofolder persons with moderate and mild dementia were 55.3% and 31.6% respectively. For bothmales and females, the majority of clients completing the MMSE were suffering from moderatedementia with percentages of 62.5% and 53.3% respectively. However, among older adults withsevere dementia, there were twice as many males as females.Table 18: Mini Mental State Examination result (N=38)MMSE score*(Total=30)Kowloon Bay(n=28)Sham Shui Po(n=6)Lai King(n=4)n (%) n (%) n (%)

5With reference to the itemized scores in the MMSE, “attention and calculation” and “recall” werethe items in which MIHC clients scored the lowest (Table 19). Despite the fact that the majorityof older people in Hong Kong did not received formal education, the language items were thehighest scores among those who required further assessment by the MMSE.Table 19: Mini Mental State Examination result by item (N=38)MMSE score(Total=30)Time orientation(max score 5)Place orientation(max score 5)Kowloon Bay(n=28)Sham Shui Po(n=6)Lai King(n=4)Mean (SD) Mean (SD) Mean (SD)2.46 (1.67) 1.67 (1.86) 3.75 (1.50)2.68 (1.72) 3.00 (1.79) 4.00 (1.16)Registration(max score 3)2.29 (1.18) 2.67 (0.52) 2.00 (1.41)Attention & calculation(max score 5)1.36 (1.63) 1.17 (1.60) 0.00 (0.00)Recall (max score 3) 1.18 (1.31) 1.33 (1.21) 0.75 (0.96)Language (max score 9) 7.25 (2.17) 7.17 (1.72) 7.50 (0.58)Total 17.21 (6.24) 17.00 (3.90) 18.00 (4.69)31

55.10 PainAs shown in a local study of chronic pain by Ng, Tsui, & Chan (2007), the prevalence, pattern andcharacteristics of chronic pain in Hong Kong are similar to those seen in Western countries. Acommunity-based survey on the prevalence of pain in Hong Kong showed that as age increases(from 18 to the 60’s), the prevalence of pain increases (27.8% to 60.1%), with a slight decreaseamong senior citizens (over 65) (Chung & Wong, 2007).We used the validated Brief Pain Inventory (BPI) to assess pain intensity, the effects of pain onlifestyle, and ways of coping with pain. Overall, pain prevalence was 46.5% (446/960). Figure 8shows the five most common sites of pain reported by clients.Right KneeLeft KneeFigure 8: The 5 commonest sites of pain reported by the clients (N=446)32

5Pain mostly affected clients’ mobility and daily activities (Table 20). Most of them applied ointment,plasters, or took non-opioid analgesics for pain relief (Figure 9). The Advanced Practice Nurses ofMIHC provided pain management programmes for them with satisfactory results.Table 20: Extent of effect of pain on daily activities (N=446)Area affected by painwithin 24 hoursKowloon Bay(n=194)Sham Shui Po(n=150)Lai King(n=102)Score (SD) Score (SD) Score (SD)Daily life activity 3.63 (3.2) 3.83 (3.2) 2.9 (2.9)Emotion 3.38 (3.5) 3.88 (3.2) 2.27 (3.0)Mobility 4.25 (3.5) 3.91 (3.3) 3.47 (3.1)Work 3.97 (3.5) 3.42 (3.3) 2.78 (3.0)Relationship with others 1.86 (2.8) 1.79 (2.8) 0.95 (2.3)Sleep 3.22 (3.4) 3.7 (3.5) 2.37 (3.2)Interest 2.58 (3.2) 3.29 (3.3) 1.9 (2.9)Number of users250 2302001501005010537 33 27 15 14 11 7 2 1 151 400Pain relieving modalitiesFigure 9: Commonly used pain-relieving modalities (N=446)33

55.11 Oral hygieneTwo hundred and nineteen older people completed oral hygiene assessment as at 31 December2008. Table 21 and 22 show the results.Table 21: Condition of oral cavity by district (N=219)Condition of oralcavityKowloon BaySham Shui PoLai King(n=101)(n=70)(n=48)n (%) n (%) n (%)Presence of dentures 60 (59.4) 43 (61.4) 29 (60.4)Good buccal mucosaconditionPresence ofcandititisPresence of gumbleedingInadequate salivarysecretion101 (100.0) 70 (100.0) 48 (100.0)1 (1.0) 0 (0.0) 0 (0.0)0 (0.0) 0 (0.0) 0 (0.0)16 (15.8) 5 (7.1) 3 (6.3)Table 22: Subsequent follow up for those with denture (N=132)Condition of denturePresence of loosely fittingupper denturePresence of loosely fittinglower dentureDenture with goodconditionKowloon BaySham Shui PoLai King(n=60)(n=43)(n=29)n (%) n (%) n (%)13 (21.7) 6 (14.0) 2 (6.9)15 (25.0) 7 (16.3) 2 (6.9)54 (90.0) 33 (76.7) 23 (79.3)34

560.3% of the sample had dentures, and 50.2% of the sample had kept their dentures in goodcondition. More than 15% of our clients had poorly fitting denture. The reasons for not fixing thedenture problems were mainly financial or lack of denture care providers near their residentialareas. Only 4.1% of clients with dentures used the correct method of denture cleansing. Someeven had mis-conceptions, such as that they need to wear their dentures during sleep (11.4%) andthat they should brush them with toothpaste (35.2%). These figures illustrate that there is a greatdemand for dental care among our older citizens. The dental assessment also revealed 11.0%of the clients had inadequate salivary secretion and 0.4% had candidiasis. Inadequate salivarysecretion can cause infections (e.g.,dental caries), mucositis, and dysphagia, and can contribute topoor denture fitting (Turner & Ship, 2007). Our dental findings may explain why poor nutrition iscommon among our clients.5.12 Visual acuityVisual acuity assessment was introduced in September 2008. Only 132 clients completed visualacuity assessment (Table 23), and of these 20.5% required visual aids. Nearly one-third had somelevel of visual impairment. The overall mean (SD) Snellen score was 13.3 (8.6).Table 23: Visual acuity by district (N=132)Visual acuityKowloon Bay(n=51)Sham Shui Po(n=46)Lai King(n=35)n (%) n (%) n (%)Required visual aids 8 (15.7) 10 (21.7) 9 (25.7)Snellen scale score > 12 17 (33.3) 12 (26.1) 14 (40.0)35

55.13 Biomeasurements5.13.1 Blood pressureAs recommended by the U.S. Department of Health and Human Services (2004), systolic bloodpressure (SBP) is a more potent cardiovascular risk factor than diastolic blood pressure (DBP) afterthe age of 50. Among all the older adults studied here, about 22.8% of males and 21.2% of femaleshad a normal SBP (i.e. SBP160mmHg or DBP >100mmHg), the hypertension in systolicpressure was 39.8% in males and 40.6% in females. However, nearly one-third of the older adults(range from 24.7%-37.4%) had blood pressure at the prehypertension stage (SBP120-139mmHg orDBP 80-89mmHg) (Table 24).Table 24: Blood pressure by gender by district (N=1053)Blood pressure(mmHg)SystolicDiastolicKowloon Bay Sham Shui Po Lai KingMale(n=136)Female(n=330)Male(n=155)Female(n=207)Male(n=65)Female(n=160)n(%) n(%) n(%) n(%) n(%) n(%)

55.13.2 Pulse rateThe mean pulse rates (beats/minute) were 72.6 beats/minute for males and 71.4 beats/min forfemales (Table 25). There was no significant difference in pulse rates among all service locations.Table 25: Pulse rate by gender by district (N=1019)Pulse rate(per min)Mean (SD)Kowloon Bay Sham Shui Po Lai KingMale(n=135)72.5(13.8)Female(n=303)71.0(14.0)Male(n=155)72.5(16.5)Female(n=204)70.7(11.4)Male(n=64)73.0(11.3)Female(n=158)72.9(11.3)5.13.3 Body mass index (BMI)As recommended by the World Health Organization, Asians with a BMI of up to 30 kg/m 2 areconsidered overweight, and those measuring 30 kg/m 2 or above are considered obese (Choo,2002). Nonetheless, the Chinese Ministry of Health has recommended that those with a BMI of24 kg/m 2 or more should be considered overweight and those with a BMI of 28 kg/m 2 or higher asobese (Yang et al., 2008). The percentages of older adults with a recommended BMI (18.5-23.0kg/m 2 ) were 34.4% in females and 35.0% in males which was about one third of the total sample only.As stated by Yang and colleagues (2008), 22.8% of Chinese people were overweight in 2002 and7.1% were obese. According to our records, by contrast, 55.6% of MIHC clients were overweightand 5.0% were obese (Table 26).Table 26: BMI by gender by district (N=997)GenderMaleFemaleKowloon Bay Sham Shui PoLai KingBMI(n=432)(n=345)(n=220)(kg/m²)*n (%) n (%) n (%)

55.13.4 Waist-to-hip ratioGrogan (2009) states that a waist-to-hip ratio of 0.85 or higher in females and 0.90 in malescontributes to an increased risk of cardiovascular diseases. Besides, a waist-to-hip ratio of 0.91 andabove is associated with a nearly threefold increased in the risk of coronary heart disease. In oursample, 61.8% of males and 80.2% of females had an undesirable waist-to-hip ratio (Table 27).Table 27: Waist-to-hip ratio by gender by district (N=1009)GenderMaleFemaleWaist-to-hipratio*Kowloon Bay(n=432)Sham Shui Po(n=354)Lai King(n=223)n (%) n (%) n (%)≤0.9 51 (38.1) 53 (35.1) 29 (46.0)>0.9 83 (61.9) 98 (64.9) 34 (54.0)≤0.85 61 (20.5) 44 (21.7) 26 (16.3)>0.85 237 (79.5) 159 (78.3) 134 (83.8)* For male, Waist-to-hip ratio >0.9=increasing risk of cardiovascular disease; for female, Waist-to-hip>0.85=increasing risk of cardiovascular disease38

6 Client Satisfaction SurveyAsurvey was conducted by telephone using a validated integrative health satisfactionquestionnaire. Participants were asked to rate the integrative health care that they hadreceived from MIHC in various dimensions, to identify area(s) for improvement and their overallsatisfaction.Eight hundred and sixty-three elderly clients were in the registry at the time of the survey. Twohundred and thirty-four of them did not have phone numbers. Six hundred and twenty-ninewere eligible for the telephone survey. One hundred and seventy-five (27.8%) were unable tobe contacted, 72 (11.6%) refused to participate and 382 eventually completed the survey. Theresponse rate was 60.7%.Table 28: Demographic profile of the participants (N = 382)Demographic characteristicsGenderAge groupEducationKowloon Bay(n, %)Sham Shui Po(n, %)Lai King(n, %)Male 48 (12.6) 35 (9.2) 38 (9.9)Female 136 (35.6) 54 (14.1) 71 (18.6)60-69 37 (9.7) 34 (8.9) 42 (1.0)70-79 96 (25.1) 46 (12.0) 54 (14.1)≥ 80 51 (13.4) 9 (2.4) 13 (3.4)No formal education 82 (22.1) 29 (7.8) 48 (12.9)Primary school 67 (18.1) 30 (8.1) 45 (12.1)Secondary school 30 (8.1) 23 (6.2) 10 (2.7)Tertiary or higher 1 (0.3) 4 (1.1) 2 (0.5)Table 29: Frequency distribution of services attended by subjects (N = 382)Type of service n %Comprehensive health assessmentBiomeasurement 382 100.0Multi-dimensional health assessment 336 88.0Dental and oral hygiene assessment 76 19.9Therapeutic managementHealth consultation (e.g. diabetes consultation) 214 56.0Counselling 190 49.7Pain management(e.g. exercise training, foot massage, Bowen therapy)86 22.5Health talk/education 54 14.139

6Tables 28 and 29 show that the vast majority of the respondents were satisfied with the servicesreceived and the healthcare professional’s performance, except with regard to waiting time (61.6%)(Table 30 and 31).Table 30: Satisfaction with the services received (N = 382)Satisfied Appropriate UnsatisfiedAspect of service(n, %) (n, %)(n, %)Quality 309 (82.2) 52 (13.8) 15 (4.0)Environment 278 (86.9) 35 (10.9) 7 (2.2)Promotional materials 85 (84.2) 14 (13.9) 2 (2.0)Telephone booking/enquiry system 115 (86.5) 14 (10.5) 4 (3.0)Waiting time 162 (61.6) 64 (24.3) 37 (14.1)Contact time per visit 300 (80.6) 48 (12.9) 24 (6.5)Table 31: Satisfaction with healthcare professional’s performance (N = 382)Aspects of performanceSatisfied Appropriate Unsatisfied(n, %)(n, %) (n, %)Knowledge 293 ( 88.0) 32 (9.6) 8 (2.4)Proficiency 299 (87.9) 37 (10.9) 4 (1.2)Responses to enquiry 317 (95.5) 13 ( 3.9) 2 (0.6)Willingness to help 345 (95.3) 13 (3.6) 4 (1.1)Politeness and patience 369 (96.9) 11 (2.9) 1 (0.3)Effectiveness of therapies 189 (81.5) 34 (14.7) 9 (3.9)Waiting time and the effectiveness of therapies were rated as the least satisfactory aspects. Thenumber of visits was significantly associated with service quality, environment, waiting time,understanding of the services provided, response to enquiry and effectiveness of therapies (p< 0.05). The willingness to revisit was influenced by the services received, understanding of theservices provided, response to enquiry, willingness to help, politeness and patience, and efficacy oftherapies (p < 0.05). Service diversity and service hours were the suggested areas for improvementin future services. The relatively low satisfaction with waiting time and effectiveness of therapieswas caused by the limited resources and short in-service period. Their significant association withthe willingness to revisit urges improvement in these areas.In summary, the results of the survey demonstrate that the older adults who took visited the MIHCaccepted integrative health care.40

7 Client AppreciationWewere encouraged to receive compliments from our clients, both internal and external.These include appreciation letters and handicrafts from our clients, anecdotes fromstaff, students, community partners and requests of service from NGOs. Examples are shown inFigure 10-16.These show that the MIHC service has received wide acceptance among the public. Traditionally,primary healthcare services target disease prevention. As a pioneer healthcare provider, the MIHChas tried to adopt strength enhancement and positive thinking as the vision of care provision. As aquality team, we believe that promoting one’s ability instead of fighting inability is the ultimate goalof care provision. These messages substantiate our belief that empowerment and care provisionare meaningful to the aged. It also proves that our team’s work really has a positive influence onour clients and can help to develop harmonious collaboration with the community partners forthe better use of resources.Figure 10: Feedback from a medical doctor of Hospital Authority41

7Figure 11: Hand-made handicrafts from MIHC client for appreciationFigure 12: Letter from client-I42

7Figure 13: Letter from client-IIFigure 14: Letter from client-III43

7Figure 15: Anecdotes from a staff in MIHCFigure 16: Anecdotes from a nursing student of the Texas University44

8 Capacity BuildingThequality and dedication of our staff is key to MIHC’s success. Knowing this, we held anumber of training are sessions for staff, nursing student helpers and volunteers.8.1 Counselling skillsA local study revealed an increase in visits to accident and emergency departments in regionalhospitals among depressive older persons in the twelve months prior to their diagnosis withdepressive disorders (Chan, Shea, & Mak, 2007). To ease the burden on the health care system,prevention of depression or early screening is essential. In view of the service need, the MIHCteam attended a series of training workshops in counseling skills in order to facilitate psychosocialinterventions with the at risk group of depressive older people.8.2 Knowledge managementAdvancement in technology has contributed to the shift of disease patterns from acute to chronic inrecent decades. Nowadays, technology is inseparable from health care. Knowledge managementis classified by the WHO as a core function in organizational development in some regional services.Consistent with the global trend, a number of the MIHC team members attended a certificatecourse in knowledge management from March to June 2008. Equipped with the most up-to-dateknowledge and the enthusiasm in serving the older adults, quality care is assured.8.3 Pain management internshipUntreated pain can severely affect one’s quality of life and imposea huge burden on the health care system. As stated out by theAmerican Pain Foundation (2005), pain caused 1 in 3 Americanadults to lose more than 20 hours of sleep per month and itsmanagement costs an estimated $100 billion each year. In orderto educate our next generation of nursing professionals, thenurse team conducted a series of pain internships in May 08 andAugust 2008. Lecture and practical session on assessment andpain management skills with a focus on knee and shoulder pain(two of the most commonly reported painful sites) was deliveredto bachelor nursing students at The Hong Kong PolytechnicUniversity. Some protocol-driven therapies in the MIHC, suchas Bowen therapy and bodyblade programme, were introducedto the students.Pain Internship45

9 Social Contributions & RecognitionWeare aware of the importance of contributing towards a healthier society andempowerment of the older adults in maintaining active and healthy ageing. We workactively to promote social contribution activities using the icon of MIHC and our expertise in healthso as to address the needs of the communities locally, nationally and internationally. A descriptionof our social contribution is presented below.9.1 Training of volunteers - AMSAs a pioneer in community care, MIHC was invited to join theIslander Project run by the Auxiliary Medical Service (AMS).To equip the AMS with skills in providing community service,the MIHC mentored 26 AMS members. After receiving a fivehour lecture, the 26 AMS members attended two days of onsitetraining during November and December 2008. In thementorship programme, the APNs coached the AMS membersin provision of primary health care and bio-measurementassessment, and communication skills in service delivery to theelderly.Training to the Auxiliary MedicalService volunteers9.2 Free public lectures, seminars and workshopTo encourage social participation among older persons andto arouse their awareness of contemporary health issues, theMIHC gave a number of health talks in collaboration with localNGOs or district councilors (Table 32). These health talks wererepeated in different districts.MIHC team giving hypertension talkin a community centreMIHC team givingExercise HealthTalk46

9Table 32: Health talks, workshops and seminars given by MIHCApril 2008May 2008June 2008July 2008August 2008August 2008September 2008October 2008October 2008November 2008December 2008Flu Seminars for Older Adults( 流 感 知 多 少 )Knowing EV71 and Hand Foot Mouth Disease( 認 識 腸 病 毒 71 型 及 手 足 口 病 )Smart eating in control diabetes( 精 明 飲 食 控 制 糖 尿 病 )Nurturing Diet based on traditional Chinese medicine( 食 療 與 養 生 )Silent Killer - Hypertension( 沉 默 的 殺 手 – 血 壓 高 )Nutrition Workshop_ Strength building by wise choice of food( 如 何 運 用 食 物 抵 抗 疾 病 )_ Smart diet tips for old people( 長 者 飲 食 要 訣 )_ High nutritional value, low food price( 什 麼 是 最 抵 買 的 食 物 ? 要 價 格 與 營 養 兼 備 !)Exercise Workshop for the Aged( 運 動 與 健 康 生 活 )Healthy way of weight control( 健 康 有 「 營 」Keep Fit 有 「 法 」)Participation in the Science in Public Service Fun Fair( 科 學 為 民 嘉 年 華 )Providing free health assessments to older adults with mentalretardation in the opening ceremony of the CHEERS programme( 頤 康 健 康 日 )47

99.3 Academic and professional visitsAs a new primary health care model in providing community service, the MIHC was visited byinternational scholars. Details of the visits are shown in Table 33.Table 33: Academic and professional visitsApril 2008May 2008June 2008July 2008August 2008September 2008October 2008November 2008December 2008____________________Data Asia Technology Ltd. &Yu Jianguo, Vice Secretary-General, Shanghai Foundationfor the Aged( 上 海 市 老 年 基 金 會 余 建 國 副 秘 書 長 )Prof. Nancy Fugate Woods, Dean of the School of Nursingand Professor in the Department of Family and Child Nursing,University of WashingtonDr. Qun Meng, Deputy Director General,Department ofMedical Science, Technology and EducationMinistry of Health, People's Republic of China( 中 國 國 家 衛 生 部 科 技 教 育 司 孟 群 副 司 長 )Advanced Practice Nurse students from Yale UniversityMr. Schwinger Wong (Senior Officer for East Kowloon of TheHong Kong Society for The Aged)張 振 露 女 仕 ( 廣 東 省 護 理 學 會 理 事 長 )Accreditation panel members (The Hong Kong NursingCouncil)Professor David Arthur (Head of School of Nursing & DentalHygiene of National University of Singapore )Ms. Amy O. Lam (Deputy Manager of ASTRI)Mr. Edward S. Yang (Chief Executive Officer of ASTRI)Mr. Chih-Lin I. (Vice President of ASTRI)Mr. Li Geng (Research &Development Director of ASTRI)Ms. Joey C.Y. Chow (Senior Engineer of ASTRI)Professor Isabel Amélia Costa Mendes (Director of theWHOCC)Dr. Jean Yan (WHO)Dr. WM Chan (Assistant Director, Family and Elderly HealthServices of the Department of Health)Ms Grace Lo (Caritas Rehabilitation Service)Ms. Y.Q. Pan (The Director of the International NursingProgram at Jin Hua Vocational Technical College)Two students (Ms. S.Y. Chi & Ms. N.A. Zainal) from theDepartment of Nursing of the Faculty of Medicine of theUKMA group of physiotherapists from the Hong Kong BaptistHospital48

99.4 RecognitionIn 2008, the MIHC has won two ICT awards, namely Best Lifestyle Award Grand Award and Best LifestyleAward (Social Life and Community) Award, for its innovation and contribution to better lifestyle in teleprimaryhealth services to the older adults. Award ceremony will be held in 2009. With these awards, wecan use the logos for 3 years for our MIHC activities (Figure 17 and 18). The team will continue with its workaiming at empowering the community dwelling older adults.Figure 17: Logo for Best Lifestyle Award Grand AwardFigure 18: Logo for Best Lifestyle Award (Social Life andCommunity) Award49

10 Service EvaluationToensure our service meets the objectives of the MIHC and the demand of the community,we have carried out a SWOT analysis. SWOT analysis is important for evaluation andfuture strategic development (Table 34). In SWOT, “strengths” and “weaknesses” relate to internalaspects of the organization, while “opportunities” and “threats” examine the external factors thatcan influence how MIHC approaches and accomplishes its goals. Defining weaknesses and threatshelps us focus our efforts.Table 34: SWOT analysis for MIHCStrengths1. Case management2. Multidisciplinary team3. Integrative health approach4. Clinical expertise5. Telehealth system6. HL-7 standard for database7. Data privacyWeaknesses1. Inadequate number of MIHC2. Manpower3. Funding sourceOpportunities1. Well established expertise in telehealth andintegrative health with a defined marketniche2. High demand for primary care3. Escalating incidence of chronic healthproblem and ageingThreats1. Availability of parking space for MIHC inhousing estates (Hong Kong)2. Weather3. Interruption of wireless technology4. Economy recession50

1010.1 Strengths10.1.1 Case managementA key strength of the MIHC is the implementation of casemanagement with the Advanced Practice Nurse as casemanager. The case manager assesses manifested complaintsand detect hidden problems, initiates interventions (engaging,empowering, evaluating and separating) to alleviate complaintsand improve quality of life for clients, makes referrals throughthe correct networks, co-ordinates care provided by otherhealth professionals, performs variance tracking, investigatescosts and benefits and gathers evidence for research. This canensure continuity as well as quality of care.10.1.2 Multidisciplinary teamMIHC multidisciplinary teamThe team consists of Advanced Practice Nurses, traditionalChinese medicine practitioners, and nutritionists. They are allvery experienced in taking care of clients with degenerativeand chronic conditions. Apart from the health professionals,the MIHC has a team expert in both information technologyand engineering. With the support of the team, cuttingedgetechnology could be utilized in care provision in thistechnological era.Prof Joanne Chung and MIHC technicalofficers51

1010.1.3 Integrative health approachIntegrative health is an integration of conventional,complementary and alternative health care with a view tobringing the most benefits to an individual for his well being.Integrative health adopts a holistic approach (biopsychosoicalspiritual) in the course of care delivery. It also emphasizestherapeutic relationship. In addition to conventional care, theMIHC has introduced various kinds of integrative therapies to thenew model of care. Incorporating ideas like traditional Chinesemedicine and positive self-cultivation, this model yields a widerange of supports among older persons. Quality assurance ofthe service is evaluated by the implementation of interventionalgorism and the holistic approach in enhancing well-being,controlling chronic health problems, empowering individuals(and families). These are taken care of in the case conferences whilecase managers are to ensure that integrative health is delivered.MIHC traditional Chinese medicinepartitioner delivered nurturtion talk10.1.4 Clinical expertiseApart from high flexibility brought about by the mobilesetting, an expert nursing team is another strength ofthe MIHC. The nursing team of the MIHC consists ofexperts in different specialties like aromatherapy, DMcare, pain management, palliative care and surgical care.An experienced team can offer prompt referrals, nonpharmacologicalinterventions and means to promote health,not simply manage disease.MIHC Advanced Practice Nurse carryingout visual acuity assessmentProf Joanne Chung (middle), Dr AnthonyWong (left 3) Advanced Practice Nursesand registered nurses in MIHC52

1010.1.5 Telehealth systemThe award-winning Telehealth and Telecare platforms thatwe have developed over the past few years are another keystrength of MIHC. Telehealth improves existing diagnostics andtherapies by combining efficient forms of IT with proven clinicalapproaches for personal health monitoring. This also builds alife-long health record for each client of MIHC. With the aid ofthe Telehealth system, experts in different settings can provideinput at any time from any place. This system is economical andefficient, for both clients and doctors.MIHC nurse using the health assessmentkiosk to measure client’s blood pressure10.1.6 Health Level-7 (HL 7) database standardIn Hong Kong, the Hospital Authority (HA) introduced aPublic-Private Interface (PPI) to facilitate the sharing of clinicalinformation. The introduction of the PPI aimed at offeringpatients with more choices of care in a well-integrated publicand private healthcare system. The MIHC system adopted theHL7 standard (HA version 1.2.0 on June 2007), which acts asan electronic data communication protocol at the applicationlevel, in service provision. In this way, MIHC can serve the HAmore easily and efficiently.MIHC client using self-assisted healthassessment kiosk53

1010.1.7 Data privacyTo save the environment and to increase the accuracy of data, the MIHC uses an electronic formatof documentation which is based on a tailor-made kiosk system for health assessment and datacollection. This system minimizes the manual input of clients’ information, thus saving manpower.In providing continuity of care by using a mini-station, large volume data transactions are inevitable.As a consequence, data security is an important issue for the MIHC. To ensure data security, theMIHC adopted sets of user levels with passwords for accessing the kiosk system. All access to thesystem is logged and no user can export data from the kiosk system. Moreover, all data is encryptedbefore data interchange. In order to protect data privacy, only authorized personnel are able toaccess and retrieve from the database system.10.2 Weaknesses10.2.1 Inadequate number of MIHCsIn Hong Kong, there is currently only one MIHC. Although the service is widely supported by thecommunity, only three service locations can be served. Even in these three locations, which aredensely populated with a huge demand, only a small population of the needy can be served. Wecannot meet the demand with only one MIHC.54

1010.2.2 ManpowerOwing to increasing demand and its success, the MIHC wasinvited to provide services in new locations. However, withlimited resources and manpower, in order to introduce anew service, service in an existing location would have to becut. Moreover, in order to cope with increasing demand ofneedy in disease prevention and health maintenance, theteam sets up four non-pharmacological health services whichinclude pain management, diabetes care consultations,exercise therapy and diet workshop training. With increasingservice demand, manpower should increase simultaneously.However, this has not been possible. In other words, lackof manpower may undermine the continuity of care to theneedy. Already, waiting time for MIHC service has increased,with detrimental implications for all levels of service.Pilot clinical trial in Lai King District10.2.3 Funding sourcesThe MIHC is primarily supported by external funding. It keeps alife-long health records for individuals as well as a comprehensivepicture of the community. Ideally, MIHC serves the needy elderly, aswell as local concerned personnel and the policy- makers. In orderfor MIHC to provide a sustainable service, a stable funding sourceis of great importance in order to sustain and improve service.While the initial funding received from our honourablephilanthropist Mr. Edwin S.H. Leong was truly generous, along-term funding source is now needed in order to achievea high quality individual and community empowerment. TheMIHC, we believe, has proved its value in the community, andpromises to continue to deliver greater benefits if it can developand expand.MIHC exercise workshopMr. Edwin S.H. Leong tried the bodybladein MIHC55

1010.3 Opportunities10.3.1 Well established expertise inTelehealth and integrative healthWith prompt intervention includingmodification of lifestyle and early treatment,the chances and speed of recovery fromvirtually every condition are greatly increased.In addition, in order to have successful primaryhealth care, an efficient, accurate and up-todatemeans of maintaining personal healthcare records that can be shared among differenthealth care sectors as well as all health careprofessionals is alsoneeded.One hindrance mightbe the incomplete andunshared personal lifelonghealth care records;n o n - t r a n s f e r a b l einformation mightresult in delay ofproper health advice and treatment. With theoutstanding track records created by the teamon the development of the new Telehealth andintegrative digital health area, MIHC currentlyis trying to bring this new era of health caremanagement into reality.10.3.2 High demand for primary careIt has long been recognized that a largenumber of older people are among theless privileged groups in Hong Kong. Hightransportation cost and their typically loweducation level frequently prevent them fromparticipating in health-promoting behaviourssuch as attending health screening and healtheducations, and engaging in social interaction.Provision of primary care is essential in givingpeople the right service at the right time,before they are admitted to hospital, often asan emergency. Hence, there is an increasingdemand for primary care.10.3.3 Escalating chronic healthproblems and ageingAccording to the government, it has beenprojected that more thana quarter of the localpopulation will be 65years or older in 2033,and the dependencyratio of 2 dependents to5 independents will occurnot later than 2019. Suchchange will pressure publicfinances especially in termsof rising health care costs. In addition, ageingis associated with increasing chronic anddegenerative diseases such as heart diseaseand diabetes. These diseases increase the riskof morbidity, mortality, and health care costsand, more importantly perhaps, they decreasethe quality of life. On the one hand, theescalating incident of chronic health problemsand ageing promise to create a huge burden onthe secondary and tertiary health care system.On the other hand, such a trend represents agreat opportunity to develop primary healthcare.56

1010.4 Threats10.4.1 WeatherAlthough the mobile setting improved the accessibility to target clients who were restricted totheir local community by either high transportation costs or poor physical functioning, the mobilenature of the service was a double-edged sword in that it resulted in some limitations to serviceprovision. During 2008, service was suspended on 20 days due to bad weather such as typhoons,very hot or very cold weather warnings and rainstorms. As we know, poor weather is a risk factorcausing accidents like fall among older persons. Hence, MIHC was hindered from service provisionduring bad weather. Furthermore, in order to provide good ventilation, the MIHC was sent formaintenance, resulting in an 11-day service suspension. To tackle such limitations, the team triedsetting up a mini-station in collaboration with a local NGO – SAGE. With the help of SAGE, serviceprovision was stabilized in Kowloon Bay District. For stabilizing the service provision, we areseeking opportunities to set up mini-stations in other service locations, e.g. Lai King District.10.4.2 Availability of parkingDue to the rising popularity of the service in some regions, various parties have approached theMIHC, asking it to come-- especially for old public housing estates. Despite the benefits that amobile setting provides, the large physical size of MIHC did also limit the service provided becauseit can only go where there is a parking space large enough to accommodate it.10.4.3 Interruption of wireless receptionWireless technology is developing rapidly in Hong Kong; however, the development pace inresidential areas is relatively slow especially in older public housing estates. Therefore, the usageof the Telehealth system in MIHC has been hindered by unstable wireless service.10.4.4 Economic recessionThe recent economic recession has had a significant financial influence on MIHC because externalfunding is its primary financial source. There is increasing difficulty in finding funding source fordevelopment in Tele-primary health service in MIHC. At the same time, the recession means anincreasing demand for free primary health service. Financial stress has become a critical issue forthe sustainability of MIHC.57

11 The way forwardCurrently,health care services are delivered to senior citizens in hospitals, clinicsand community centres, the locations of which are mostly fixed. Whenseniors need health care, they have to travel to these locations, which can present a challenge and dangerto them because of their immobility and the inaccessibility of the facilities. Providing a mobile channel todeliver health care service to needy people, especially older adults near their residential area, is a feasiblesolution to reducing this problem.To build on what we have done in the last twelve months, the Team will continue to:1. Strengthen this collaborative model by mobilizing partners and taking strategic actions, e.g.running handicraft workshops by older adults for peers, empowering self-efficacy in managingchronic conditions and developing collaborative data-based health programme.2. Continue the implementation of case management and develop intergrative clincial protocols forselected chronic health conditions, e.g. pain, hypertension and diabetes mellitis.3. Establish mini-stations to meet the increasing demand of service and to test the feasibility of theMIHC model in different settings. We will work closely with Non-governmental organization for this.4. Test the market value of the MIHC as an alternate health provision model for Hong Kong older adultsby introducing charges in selected services on a cost-recovery basis. If the response is positive, we willencourage other primary care providers and NGOs to provide service in their facilities following thesame model where the community resources are sometimes limited. This can also serve as the initialstages towards susbtainability.We hope this concept of mobile health care delivery will be transferred to and eventually adopted bythe community in a larger scale. Therefore, the systemic collaboration and resource sharing between theuniversity and community health care workforce can be enhanced to satisfy the increasing needs fromageing population in Hong Kong.Good sustainability comes from having a firm foundation and strong vision.The team will continue to draw upon on a broad spectrum of fields: informationscience/electronics, nursing care and biomedical science while we will strive todevelop strategies for substainability.Recognising that both vision and risk-taking shape smart, pragmatic decisions,the next step in the Centre’s vision is to enhance the current services bystrengthening the flourishing relationships that exist among and betweenour team members, the University, sponsors and community groups. We willcontinue with these endeavours to meet the healthcare needs of older adultsin Hong Kong.58

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12 ReferencesShum, N.C., Hui, W.W.H., Chu, F.C.S., Chai, J., & Chow, T.W. (2005). Prevalence of malnutrition and risk factorsin geriatric patients of a convalescent and rehabilitation hospital. Hong Kong Medical Journal, 11(4), 234-242.Social Welfare Department. (2009). Statistics and figures on social security. Retrieved February 12, 2009,from, A.C., Chang, J.M.C., Lin, H., Chuang, Y.L., Lin, S.H., & Lin, Y.H. (2004). Assessment of the nutritional riskof >53-year-old men and women in Taiwan. Public Health Nutrition, 7(1), 69-76.Turner, M.D., & Ship, J.A. (2007). Dry mouth and its effects on the oral health of elderly people. Journal ofAmerican Dental association, 138, 15s-20s.U.S. Department of Health and Human Services. (2004). The seventh report of the joint national committeeon prevention, detection, evaluation, and treatment of high blood pressure. Retrieved 1 June, 2008, from, B., Guigoz, Y, Arry, P.J., Nouhashemi, F., Bennahum, D., & Lauque, S, et al. (1999). The mini nutritionalassessment (MNA) and its use in grading the nutritional state of elderly patients. Applied NutritionalInvestigation, 15(2), 116-122.Visvantha, R. (2003). Under-nutrition in older people: a serious and growing global problem. Journal ofpostgraduate Medicine.49:352-360.World Health Organization. (2002). Active ageing – a policy framework. Retrieved February 10, 2009, from Health Organization. (2004). World Health Organization launches new initiative to address the healthneeds of rapid ageing population. Retrieved February 7, 2009, from Health Organization. (2005). Preventing chronic diseases – a vital investment. Retrieved October 24,2008, from Health Organization. (2006). Population proportion over 60. Retrieved February 10, 2009, from WorldHealth Organization statistical information system database.World Health Organization. (2007). Mental health and substance abuse. facts and figures. Retrieved February7, 2009, from, G., Kong, L., Zhao, W., Wan, X., Zhai, Y., & Chen, L., et al. (2008). Health System Reform in China 3 -emergence of chronic non-communicable diseases in China. Retrieved February 7, 2009, from

AcknowledgementThe PolyU–Henry G. Leong Mobile Integrative HealthCentre is generously funded by thephilanthropist Mr. Edwin S. .H Leong.

The PolyU–Henry G. LeongMobile Integrative Health Centre

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