1. Joanne Chung School of Nursing The Hong Kong Polytechnic University hsjchung@inet.polyu.edu.hk

2. Ageing population Challenges of the 21st Century Sources of photos: Jockey Club Hong Kong and Yahoo

4. Foundation: Individual

5. Mobile Integrative Health Centre Our Target: Deprived Groups

6.  Unengaged not registered with any kind of networked programme under mainstream services; and, have genuine needs of support services; and, unmotivated to receive assistance  Partially unengaged has registered with a networked programme under mainstream services before; and, have genuine needs of support services; and, unmotivated to receive assistance /services Our Target: Deprived Groups Unique Features Self care, family care and community care Participative care focusing on empowerment Evidence based and protocol driven services Integrative Western, complementary and TCM practice, and technology Integrated cultural elements Prevent unnecessary admission to hospitals and enhance independence by optimizing their living environment:

7. The Team and Community Partners Advanced Practice Nurse Academics & Students Medical Practitioner TCM Doctor Nutritionist IT Engineer Biostatistician Researcher Publicity Staff Video Conference Community partners (NGOs, Police, Estates, District Board)

8. Telehealth System (local server) Individual & Family Health Profiling Community Health Profiling Health Statistics Centre Web-based Info CentreWeb-based Info Centre Health Promotion & Education ActivitiesHealth Promotion & Education Activities Protocol developmentProtocol development Web-based Info CentreWeb-based Info Centre Health Promotion & Education ActivitiesHealth Promotion & Education Activities Protocol developmentProtocol development MIHC – the Hub PolyU server

9. Interface

10. Some Snapshots Interview Blood pressure measurement Blood oxygen saturation (SpO 2 ) Pain assessment Dental Assessment Cognitive training Foot massage Diabetes mellitus consultation Visual acuity assessment Concentration and small muscle training Health education Nutrition talk with food samples Psychosocial counselling Exercise Pain Management Follow up

11. Telehealth System (local server) Individual & Family Health Profiling Community Health Profiling Health Statistics Centre Web-based Info CentreWeb-based Info Centre Health Promotion & Education ActivitiesHealth Promotion & Education Activities Protocol developmentProtocol development Web-based Info CentreWeb-based Info Centre Health Promotion & Education ActivitiesHealth Promotion & Education Activities Protocol developmentProtocol development MIHC – the Hub PolyU server

13. Health Profile Mobile Integrative Health Centre started its service on 16 Jan 2008 953 older adults (327 male, 626 female) registered for the service @31 August 2008

14. Age (years) Gender Service location Kowloon Bay (n = 417) Sham Shui Po (n = 325) Lai King (n = 209) MeanS.D.MeanS.D.MeanS.D. Male75.67.173.75.871.77.0 Female 76.88.072.86.471.77.3

15. Social participation Participation Service Location Kowloon Bay (389) Shum Shui Po (287) Lai King (209) Unengaged 123 (31.6%)7 (2.4%)0 Partially engaged 8 (2%)7 (2.4%)0 Engaged 258 (66.3%)273 (95.1%)209 (100%) 10.6% of the older people in HK are unengaged (12 Jan 2008) Source: http://www.takungpao.com.hk/news/08/01/21/GW-853769.htm

16. 5 major health problems Major health problems Location of service Kowloon Bay (n=418) Shum Shui Po (n=326) Lai King (n=209) MaleFemaleMaleFemaleMaleFemale n (%) Hypertension 65 (50.4)149 (51.6)52 (38.0)91 (48.2)21 (34.4)79 (53.4) Cataract 27(21.0)73 (38.6)22 (16.1)37 (19.6)8 (13.1)25 (16.9) Diabetes mellitus 23 (18.0)52 (18.0)22 (16.1)24 (16.7)7 (11.5)19 (12.8) Painful joints* 28 (21.8)68 (23.5)21 (15.3)42 (22.2)13 (21.3)38 (25.7) Hyper- lipidaemia 10 (7.8)29 (10.0)10 (7.3)21 (11.1)5 (8.2)16 (10.8) * include gout, degenerative joints and rheumatic arthritis

17. Mini Nutritional Assessment (MNA) Screening MNA screening score* Service location Kowloon Bay (n = 383) Sham Shui Po (n = 300) Lai King (n = 201) n%n%n% <1212733.29632.04019.9  12 25666.820468.016180.1 * Subjects with Mini Nutrition Assessment (screening) score <12 is considered as possible malnutrition and require to conduct the further assessment.

18. Malnutrition Indicator Score (MIS) Malnutrition Indicator Score* Service location Kowloon Bay (n = 91) Sham Shui Po (n = 39) Lai King (n = 21) n%n%n% <17.055.537.7419.0 17.0-23.5 8087.93282.11781.0 >23.5 66.6410.300.0 * Subject with MIS <17.0 is considered as malnourished and MIS  17.0 is considered as “at risk of malnutrition”.

19. Abbreviated Mental Test (AMT) AMT score* Service location Kowloon Bay (n = 383) Sham Shui Po (n = 300) Lai King (n = 201) n%n%n% <6328.5113.852.6 66 34391.528196.218797.4 * Subject with AMT score < 6 is considered as possible dementia and further test such as Mini Mental State Examination (MMSE) is required. Subject with AMT score  6 is considered as normal.

20. Mini Mental State Examination (MMSE) MMSE score* Service location Kowloon Bay (n = 26) Sham Shui Po (n = 5) Lai King (n = 4) n%n%n% <10311.50000 10-19 1350.0360250 20-26 830.8240250  27 27.70000 * MMSE score < 10 = Severe dementia, 10-19 = Moderate dementia, 20-26 = Mild dementia and  27 = normal.

21. Geriatric Depression Scale (GDS) GDS Score* Kowloon Bay (n = 356) Sham Shui Po (n = 281) Lai King (n = 188) MaleFemaleMaleFemaleMaleFemale n%n%n%n%n%n% <89085.721485.310686.213283.55398.111988.8 88 1514.33714.71713.82616.511.91511.2 GDS score < 8 = without depression GDS score  8 = depression

22. Activities of living Activities of LivingWith problems (n, %) Maintaining a safe environment43 (4.9%) Communication36 (4.1%) Eating and drinking48 (5.5%) Elimination167 (19.1%) Hygiene and grooming11 (1.3%) Mobility125 (14.3%) Working and entertainment26 (3.0%) Focus assessment 1. Concentration 2. Visual-spatial co-ordination

23. Subjective Happiness Score Subjective Happiness Score* Service location Kowloon Bay (n = 372) Sham Shui Po (n = 307) Lai King (n = 203) n%n%n% 4-741.632.031.7 8-14 228.7128.0126.8 15-21 9236.25033.35732.2 22-28 13653.58556.710559.3 * Subjective happiness score of 4 and 28 represent lowest and highest happiness respectively.

24. Dietary modification, education, dental care Nutrition Drug compliance, monitoring, exercise, education, diet DM Drug compliance, monitoring, exercise, education, diet Hypertension Life long health record: a. self-administered health assessment b. continuity of care c. participatory health management Telehealth System ++ Bowen therapy, exercisePain Dietary modification, education, dental care Nutrition Drug compliance, monitoring, exercise, education, diet DM Drug compliance, monitoring, exercise, education, diet Hypertension Life long health record: a. self-administered health assessment b. continuity of care c. participatory health management Telehealth System ++ Bowen therapy, exercisePain Dietary modification, education, dental care Nutrition Drug compliance, monitoring, exercise, education, diet DM Drug compliance, monitoring, exercise, education, diet Hypertension 1. 1.Life long health record: a. self-administered health assessment b. continuity of care c. participatory health management Telehealth System ++ Bowen therapy, exercise Pain Problems (at risk/actual) Intervention Technology applied Outcome in terms if optimizing living environment

25. Problems (at risk/actual) InterventionTechnology applied Outcome in terms if optimizing living environment Cognition Cognitive training Digital technology 1.Memory 2.Logical thinking 3.Problem solving 4.Strategic thinking

26. 1. 1.Concentration 2. 2.Visual-spatial co-ordination 3. 3.Small muscles training Haptics Safe environment Activities of living Outcome in terms if optimizing living environment Technology applied Intervention Problems (at risk/actual)

27. Problems (at risk/actual) InterventionTechnology applied Outcome in terms if optimizing living environment Social participation Story tellingVirtual Reality 1. Social interaction skills 2. Reality orientation and 3. Interest

28. 1.Empowerment‘Blended mode’MIHCPerception of self Outcome in terms if optimizing living environment Technology applied Intervention Problems (at risk/actual)

31. External Internal

34. Optimizing living environment