Conference Theme: Celebrating a decade of partnership towards accessible health care - 醫社同行十載情 齊心共創健康路Paper PresentationSeminar 1: Building Age Friendly Communities with Patients' Perspectives - 講座一: 從病人的角度與觸覺 構建長者友善社區postprin

Lou, VW

HKU Scholars Hub

Title Age-friendly health care: views from older adultsAuthor(s) Lou, VWCitationThe 10th Hong Kong East Cluster (HKEC) Symposium onCommunity Engagement, Pamela Youde Nethersole EasternHospital, Hong Kong, 11 July 2015.; Hong Kong East Cluster(HKEC) Symposium on Community Engagement X (港島東醫院聯網醫社合作研討會 (十)), Pamela Youde Nethersole EasternHospital, Hong Kong, 11 July 2015.Issued Date 2015URL http://hdl.handle.net/10722/228998Rights This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Age-friendly Health Care: Views from Older Adults  Dr. Vivian Lou Associate Professor Department of Social Work and Social Administration The University of Hong Kong &  Board Director and Chairman of Social Service Committee Hong Kong Young Women’s Christian Association 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Contents Age-friendly and well-being of older adults Methodology Key Findings Conclusion 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Age-Friendly & Well-being of Older Adults • Community and health care • Transportation • Housing • Social participation • Outdoor spaces and buildings • Respect and social inclusion • Civic participation and employment • Communication and information • Inclusion of older persons • Enable people of all ages to actively participate in community activities • Stay healthy and active even at the oldest age and provides appropriate support to those who can no longer look after themselves • Treat everyone with respects (WHO, 2004) 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing 4Ps of Personalized Health Care   4 Predictive Preventive Personalized Participatory (Personalized Health Care, 2015) 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Objective of the Study • To examine the views of older adults on how to develop a more age-friendly public health care system that is responsive to their needs. • In particular refers to in-patient care and out-patient specialized care 5 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Methodology  • Qualitative – Focus group discussion • Sample – Purposeful • Analysis – Content analyses    6 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Sampling Criteria Inclusion Criteria • Older patients 1) Aged 65 or above; 2) Older adults who have been admitted to a public hospital in HK East Cluster in the past one year (for inpatient group) or older adults who have visited a Specialist Out-patient Clinic in HK East Cluster in the past one year; 3) Voluntary participation; • Informal caregivers 1) Caregivers whose older family members were hospitalized in HK East Cluster in the past one year; 2) Voluntary participation    7 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Focus Group Discussion Guideline Inpatients Group Specialist Outpatients Group 1. Admission procedure 1. Referral, appointment and visit procedures 2.   Hardware in hospital ward 2.  Hardware in O/PT clinic 3.   Medical Services (e.g. regulations, treatment, examination, communication, patient involvement) 3. Medical Services (e.g. regulations, treatment, examination, communication, patient involvement) 4.   Discharge procedure 4. Medications (effectiveness, side effects) and procedures in pharmacy 5.   Connection with community service 5. Connection with community service 6.   Communication of information (e.g. inter-hospital, inter-departmental, community service, patient and family members) 6.   Communication of information (e.g. inter-hospital, inter-departmental, community service, patient and family members) 7.    Training of medical and other staff 7. Training of medical and other staff 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Characteristics of Participants Participants No. of  participants No. of  Sessions Male Female Median  Age Focus groups with elderly patients Inpatients 15 2 3 12 81 Outpatients of Specialist Clinic 7 1 0 7 Focus groups with caregivers of elderly inpatients 13 2 5 8 76 Total 35 5 8 27 9 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Demographic characteristics of Older Participants (I)  10 Education  Level N= 22 No education to  kindergarten Primary Junior  Secondary Senior Secondary Post Secondary University 9 2 2 3 3 3 Marital  Status N=22 Never Married Divorced Widowed Married 2 1 15 4 Living  With N=22 Live alone Live with  spouse Live with son Live with  daughter 17 3 3 1 Religious  faith N=22 Have religion No religion 12 10 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Demographic characteristics of older participants (II)  Source of  income N=22 Retirement  Benefit / Pension CSSA Old Age  Allowance Disability Allowance Old Age Living Allowance Own  Savings Caregiver's  support Other  relatives' support 2 5 5 1 6 8 4 7 11 Financial  sufficiency in the next 3 months N=22 More than  sufficient Sufficient Just  sufficient Not sufficient Very  insufficient 2 9 10 1 0  Use of  medical facilities in the past 1 yr N=22 No, of older PTs visited A&E Total no. of times older PTs visited  A&E No. of older  PTs hospitalized  Total no. of times older PTs were hospitalized  No. of older PTs visited Outpatient  Clinics  (GP/  Specialist) Total no. of times older PTs visited Outpatient  Clinics  (GP/ Specialist) No. of older PTs who used Chinese  Medicine Practitioner Total no. of times older PTs visited Chinese  Medicine Practitioner 16 26 19 32 22 104 4 21  香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Demographic Characteristics of Caregivers’ Group (I) Education  Level N=13 No education to  kindergarten Primary Junior  Secondary Senior Secondary University 4 3 1 4 1  12 Marital  Status N=13 Never Married Widowed Married Others 2 1 9 1 Job status N=13 Unsteady Retired 1 12 Income  source in past 3 months N=13 CSSA /  OALA Support from  family members Rental  income Retirement Benefit/ Pension Dividends/ Investment plan Own Savings 9 3 2 1 1 9 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Demographic Characteristics of Caregivers’ Group (II) Monthly income N=13 0-5K 5K-10K 10K-15K 6 6 1 Job  Industry N=13 Manufacturing Transportation, Warehouse, Communication Community, Social Services Others 1 4 2 6 Religious  faith N=13 Have religion No religion 5 8 Accompany older PTs to visit medical facilities in the past 1 yr N=13 No, of older PTs visited A&E Total no. of times older PTs visited  A&E No. of older  PTs hospitalized Total no. of times older PTs were hospitalized No. of older PTs visited Outpatient  Clinics  (GP/  Specialist) Total no. of times older PTs visited Outpatient  Clinics  (GP/ Specialist) No. of older PTs who used Chinese  Medicine Practitioner Total no. of times older PTs visited Chinese  Medicine Practitioner 10 31 13 38 11 40 2 6  香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Age-friendly Health Care  - A Review WHO (Groene, 2006; The International Network of Health Promoting Hospitals and Health Services, 2007) Health Promoting Hospitals and Health Services Model (i) management policy,  (ii) patient assessment,  (iii) patient information and intervention,  (iv) promoting a healthy workplace, and (v) continuity and cooperation Vancouver, Canada (Parke & Brand, 2004) Elder-Friendly Hospital Initiatives of the Vancouver Island Health Authority (i) care processes and services,   (ii) hospital systems, policies, and procedures and  (iii) communication and listening processes Taiwan (Chiou & Cheng, 2009) Framework of Age-Friendly Hospital (i) management policy,  (ii) communication and services,  (iii) physical environment, and  (iv) care process Ontario, Canada (Ryan, Liu, Awad, & Wong, 2011) Senior-Friendly Hospital (SFH) Framework (i) process of care, (ii) emotional and behavioral environment, (iii) ethics in care and research (including respect for autonomy), (iv) physical environment, and (v) organizational support New York, US (Boltz, Capezuti, & Shabbat, 2010). A geriatric acute care model (i) guiding principles, (ii) leadership, (iii) organizational structures, (iv) physical environment, (v) patient-and family-centered approaches, (vi) aging-sensitive practices, (vii) geriatric staff competence, and (viii) interdisciplinary resources and processes 14   香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Analytic Framework 15 1.  Information, Education, Communication and Training, e.g. both staff and patient education 2.  Health Care Management Systems, e.g. procedures, medical records to facilitate continuity of care 3.  Physical Environment, e.g. clean and comfortable environment (WHO, 2004) 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Findings – Care System Experiences of older adults / caregivers Expected improvements Uncertainty of waiting time for procedures: • in A&E, admission to ward, discharge procedures, and specialist outpatient clinic.  • Streamline procedures to keep patients/caregivers informed Routine services in ward :  • Disturbing Night time routine • Pre-set timetable for change of diapers, change of bedridden PTs • Assistance to showers on request • Pre-set conditions to maximize safety • Promote person-centered routine • Patient participation Medication management : • Changes in medication due to pricing • Lacking of a review mechanism on patients’ feedback/experiences • Informed changes with patient participation • Allow more flexibility for PTs who opt for self-finance drugs  Hospital / Community support Interface: • For single elderly during the process of discharge and aftercare.  • Increase discharge support for single elderly 16 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Findings – Information, Education & Training Experiences of older adults / caregivers Expected improvements Lack of Accessibility of Medical Doctors: • Difficult for family members to reach the doctor  • Doctors’ ward visits are not engaging family caregivers • Increase accessibility of doctor for caregivers  • Engage family caregivers in the whole process of care Lack of Continuity of care : • Difficult to access medical records. • Multiple doctors for a single illness. • No discharge summary available. PTs need to bring all the drugs when visiting private doctors.  • PTs received repeated examinations and questions in different wards. • Develop a shared platform to: • Improve accessibility of medical records (assessment, treatment, discharge summary, community care) among patients/caregivers/health care team • Efficient sharing of medical records Misunderstanding: • Due to unhappy experience when encountering staff who are not helpful, unfriendly, inconsiderate, and easily irritated. • Enhance communication competence • on knowledge, attitude and communication skills in dealing with older adults and caregivers. • Support health care team to manage stress. 17 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Findings – Physical Environment Experiences of older adults / caregivers Expected improvements In ward:  • Individual space; • Facilities (lightening; toilet; shower; etc.)  Patient/caregiver-centered design • Good lightening, accessible toilet; • Readable signage • Meeting area  Insufficient transportation assistance: • Transportation between hospital/clinic and home • wheelchair usage and lending • Non-Emergency Ambulance Transfer Service (NEATS) Community/Public resources • Assist in arranging transportation, pushing wheelchair for single elderly or CGs who are also elderly. • More convenient locations for borrowing and returning wheelchair.  • More volunteers • Informed NEATS service 18 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Comparison of our findings and a study of the community-based primary health care system in Ontario, Canada (Lou et al., 2015) (Lafortune, Huson, Santi, & Stolee, 2015) Care System • Uncertainty over waiting time for procedures • Routine services in ward • Medication management • Lack of hospital / community support interface Information, education, training • Lack of accessibility of medical doctors • Lack of continuity of care • Misunderstanding Physical environment • Lack of ward space and other facilities • Insufficient transportat on assistance Care System • challenges in navigating a complicated health care system • a general lack of consistency in service delivery • inconsistent follow-up care Information, education, training • Poor communication between patients and providers • roadblocks to information exchange Funding, policy • policy and funding constraints    19 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Conclusions 20 Care System Patient/Caregiver Participation Acute/Community Health/Social Cooperation Information, Education, Training Age-friendly – Value Competence Enhancement Physical Environment Innovation in Hospital / outpatient clinic design Special service for most in need groups 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Key References  • Boltz, M., Capezuti, E., & Shabbat, N. (2010). Building a framework for a geriatric acute care model. Leadership. Health Serv, 23 (4), 334-360.  • Chiou, S. T., & Cheng, L. K. (2009). Towards age-friendly hospitals and health services. Archives of Gerontology and Geriatrics, 49 (2), S3-S6.  • Groene, O. (ED.), (2006). Implementing Health Promotion in Hospitals: Manual and Self-assessment Forms. WHO Regional Officer of Europe, Copenhagen.  • Lafortune, C., Huson, K., Santi, S., & Stolee, P. (2015). Community-based primary health care for older adults: a qualitative study of the perceptions of clients, caregivers and health care providers. BMC Geriatrics, 15(57).  • Parke, B., & Brand, P. (2004). An elder-friendly hospital: translating a dream into reality. Nursing Leadership, 17(1), 62-76.  • Personalized Health Care. (2015).   Retrieved Jun 20, 2015, from http://qnphc.org/personalized-health-care/ • Ryan, D., Liu, B., Awad, M., & Wong, K. (2011). Improving older patients’ experience in the emergency room: the senior-friendly emergency room. Aging Health, 7 (6), 901-909.  • The International Network of Health Promoting Hospitals and Health Services, (2007). • The International Network of Health Promoting Hospitals and Health Services: Integrating Health Promotion into Hospital and Health Services. WHO Regional Office of Europe, Copenhagen.  • WHO (World Health Organization), (2004). Towards Age-Friendly Primary Health Care. WHO, Geneva.    21 香港大學 The University of Hong Kong 秀圃老年研究中心 Sau Po Centre on Ageing Vivian Lou wlou@hku.hk 22 

Age-friendly health care: views from older adults

Abstract

Similar works

Full text

Available Versions

HKU Scholars Hub