King, Hong Kong
King, Hong Kong

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Lee J.S.W.,Chinese University of Hong Kong | Auyeung T.-W.,Chinese University of Hong Kong | Chau P.P.H.,University of Hong Kong | Hui E.,Shatin Hospital | And 3 more authors.
Journal of the American Medical Directors Association | Year: 2014

Objective: Weight loss has been considered predictive of early mortality in nursing home residents. Lower body mass index, irrespective of weight loss, has also been considered detrimental for survival in community-dwelling older persons. We examined which of the 2 is more important for survival in nursing home residents and at what body mass index (BMI) cut-offs survival benefits are gained or lost. Design: Prospective study. Setting: Nursing homes. Participants: One thousand six-hundred fourteen nursing home residents. Measurement: Minimum Data Set at baseline and mortality status assessed at 6 months, 1, 2, 4, and 9 years later. Relationship between mortality and significant weight loss (≥5% over 30 days or ≥10% over 180 days), and BMI, was studied by Cox regression with both variables in the same model, adjusted for age, sex, medical conditions (cancer, renal failure, heart disease, dementia, hip fracture, diabetes mellitus), tube-feeding, 25% food left uneaten, swallowing problem, and the activities of daily living hierarchy scale. Results: One thousand six-hundred fourteen residents (69.5% female) with mean age 83.7 ± 8.4 years and mean BMI 21.7 ± 4.8 were studied. Mortality rates were 6.3% (6-month), 14.3% (1-year), 27.1% (2-year), 47.3% (4-year), and 78.1% (9-year). Significant weight loss was not associated with higher mortality at all follow-up durations, whereas higher BMI was significantly protective: mortality reduction per 1 unit increase in BMI were 9% at 6 months, 10% at 1 year, 9% at 2 years, 7% at 4 years, and 5% at 9 years, all at P < .001. Having ≥25% of food left uneaten (51.2% of participants) had no relationship to survival at all follow-up durations. At 9 years, compared with those with BMI < 18.5kg/m2, the normal weight (BMI 18.5-22.9 kg/m2, Asia Pacific cut-off), overweight (BMI 23-25 kg/m2, Asia Pacific cut-off) and obese (BMI 25 kg/m2, Asia Pacific cut-off) had significantly lower mortality (hazard ratio 0.65, 0.62, and 0.47, respectively, all P < .001). Conclusions: Significant weight loss as defined by the Minimum Data Set was not associated with short- or long-term survival in Chinese nursing home residents. BMI, however, is predictive of short- and long-term survival irrespective of weight loss in this population. Low BMI, detectable at a single point of time, may be another readily available alternative trigger point for possible interventions in reducing mortality risk. Obese residents had the lowest mortality compared with those with normal weight. © 2014 American Medical Directors Association, Inc.

Chan W.C.,University of Hong Kong | Fai Yeung J.W.,Chinese University of Hong Kong | Man Wong C.S.,University of Hong Kong | Wa Lam L.C.,Chinese University of Hong Kong | And 4 more authors.
Journal of the American Medical Directors Association | Year: 2015

Objective: Numerous studies have reported the prevention of falls through exercise among cognitively healthy older people. This study aimed to determine whether the current evidence supports that physical exercise is also efficacious in preventing falls in older adults with cognitive impairment. Methods: Two independent reviewers searched MEDLINE; EMBASE; PsycINFO; the Cumulative Index to Nursing & Allied Health Literature; the Cochrane Central Register of Controlled Trials; the Cochrane Bone, Joint, and Muscle Trauma Group Specialized Register;; and the UK Clinical Research Network Study Portfolio up to July 2013 without language restriction. We included randomized controlled trials that examined the efficacy of physical exercise in older adults with cognitive impairment. The methodological qualities of the included trials were appraised according to the criteria developed for the Cochrane review of fall prevention trials. The primary outcome measure was the rate ratio of falls. A meta-analysis was performed to estimate the pooled rate ratio and summarize the results of the trials on fall prevention through physical exercise. Results: Seven randomized controlled trials involving 781 participants were included, 4 of which examined solely older people with cognitive impairment. Subgroup data on persons with cognitive impairment were obtained from the other 3 trials that targeted older populations in general. The meta-analysis showed that physical exercise had a significant effect in preventing falls in older adults with cognitive impairment, with a pooled estimate of rate ratio of 0.68 (95% confidence interval 0.51-0.91). Conclusions: The present analysis suggests that physical exercise has a positive effect on preventing falls in older adults with cognitive impairment. Further studies will be required to determine the modality and frequency of exercise that are optimal for the prevention of falls in this population. © 2015 AMDA - The Society for Post-Acute and Long-Term Care Medicine.

Chan T.C.,Fung Yiu King Hospital | Chan T.C.,University of Hong Kong | Shea Y.F.,Fung Yiu King Hospital | Shea Y.F.,University of Hong Kong | And 3 more authors.
Geriatrics and Gerontology International | Year: 2012

Aim: There is no mortality prediction index for Chinese nursing home older residents. The objective of this study was to derive and validate a 2-year mortality prognostic index for them. Methods: We carried out a prospective cohort study on 1120 older residents from 12 nursing homes of Hong Kong. We obtained potential predictors of mortality and carried out updated functional assessment. Each risk factor associated independently with 2-year mortality in a derivation cohort was assigned a score based on the odds ratio, and risk scores were calculated for each participant by adding the points of risk factors present. Similar analysis was carried out on the validation cohort. Results: Independent predictors of mortality included: aged 86-90years (3 points); aged ≥91years (4 points); Charlson comorbidity index ≥4 (6 points); Barthel Index 5-60 (5 points); Barthel Index 0 (10 points); number of hospitalizations in the preceding year (Adbefore) 1 (4 points); Adbefore 2 (5 points) and Adbefore ≥3 (6 points). In the derivation cohort, 2-year mortality was 10.8% in the low-risk group (≤4 points) and 59.9% in the high-risk group (≥14 points). In the validation cohort, 2-year mortality was 11.8% in the low-risk group and 60.4% in the high-risk group. The receiver-operator characteristic curve area was 0.761 for the derivation cohort and 0.742 for the validation cohort. Conclusions: Our prognostic index had satisfactory discrimination and calibration in an independent sample of Chinese nursing home older residents. It can be used to identify older residents with a high risk for poor outcomes, who need a different level of care. © 2012 Japan Geriatrics Society.

Chan T.-C.,Fung Yiu King Hospital | Chan T.-C.,University of Hong Kong | Luk J.K.-H.,Fung Yiu King Hospital | Chu L.-W.,University of Hong Kong | Chan F.H.-W.,Fung Yiu King Hospital
Geriatrics and Gerontology International | Year: 2014

Aim: The Charlson Comorbidity Index (CCI) is commonly studied for predicting mortality, but there is no validation study of it in Chinese older adults. The objective of the present study was to validate the use of CCI in Chinese older adults for predicting mortality. Method: We carried out a retrospective cohort study from 2004 to 2013 for patients discharged from a geriatric day hospital in Hong Kong. Comorbidity was quantified using CCI, and patients were divided into six groups according to their score of CCI: CCI-0, CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5. Other data collected included demographics, and functional, nutritional, cognitive and social assessment. The outcome measure was 1-year mortality. Results: At 1-year follow up, 3.8% (n=17), 5.9% (n=37), 9.2% (n=35), 12.9% (n=20), 16.9% (n=23) and 19.3% (n=60) of CCI-0, CCI-1, CCI-2, CCI-3, CCI-4 and CCI ≥ 5 died, respectively (P<0.001). Multivariate analysis showed that CCI-1, CCI-2, CCI-3, CCI-4 and CCI≥5 have a hazard ratio (HR) of 1.34 (confidence interval [CI] 1.04-2.12), 2.18 (CI 1.03-4.61), 3.44 (CI 1.52-7.81), 3.74 (CI 1.35-10.39) and 4.63 (CI 2.28-9.43), respectively, compared with CCI-0. The area under the curve of the receiver operating characteristic curves of CCI in predicting 1-year mortality for older adults was 0.68 (CI 0.64-0.72). Conclusion: There is a significant dose-response relationship in the hazard ratio between CCI and 1-year mortality in Chinese older adults, but involvements of functional, nutritional and social assessments are important for comprehensive quantification of health status in older adults. © 2013 Japan Geriatrics Society.

Chan T.-C.,Fung Yiu King Hospital | Chan T.-C.,University of Hong Kong | Fan-Ngai Hung I.,University of Hong Kong | Ka-Hay Luk J.,Fung Yiu King Hospital | And 2 more authors.
Journal of the American Medical Directors Association | Year: 2014

Introduction: Influenza infection is common among institutionalized older adults. Many nonrandomized observational studies on influenza vaccination suggested that it could reduce influenza-related hospitalizations and mortality in institutionalized older adults. Criticism regarding the effectiveness of influenza vaccine estimated by nonrandomized observational studies include the frailty selection bias and use of nonspecific outcome, such as all-cause mortality. Methods: We conducted a systematic review of studies of influenza vaccination in institutionalized older adults to determine the effects on clinical outcomes. We searched for studies from 3 databases from 1946 to June 2013 assessing effectiveness against influenza infection. We selected studies with good comparability between vaccine group and control group. We expressed vaccine effectiveness (VE) as a proportion, using the formula VE = 1-relative risk or 1-odds ratio. We focused on the following outcomes: influenza-like illness (ILI), laboratory confirmed influenza, hospitalizations due to ILI, or pneumonia and death due to influenza or pneumonia. We did not include all-cause mortality. Results: Eleven studies that satisfied the inclusion criteria were identified, representing 11,262 institutionalized older adults. After meta-analysis, we found a significant reduction in pneumonia (VE: 37%, 95% confidence interval [CI]: 18%-53%, P = 001) and death due to pneumonia or influenza (VE: 34%, CI: 10%-53%, P = 01). There was no significant heterogeneity between studies. There was no significant publication bias. Conclusion: Influenza vaccination in institutionalized older adults could reduce pneumonia and death due to pneumonia or influenza. Influenza vaccination is recommended for institutionalized older adults. © 2014 American Medical Directors Association, Inc.

Luk J.K.H.,University of Hong Kong | Chan C.F.,University of Hong Kong | Chan F.H.W.,Fung Yiu King Hospital | Chu L.W.,University of Hong Kong
Archives of Gerontology and Geriatrics | Year: 2011

The relationship between cognitive function and geriatric day hospital (GDH) rehabilitation has not been explored. This study investigated this association in 547 older Chinese patients attended GDH. Cognitive status was assessed by Cantonese version of mini-mental state examination (C-MMSE). Functional independence measure (FIM) upon GDH admission and discharge were measured, with FIM gain = FIM discharge -FIM admission while FIM efficiency = FIM gain/by number of GDH visits. FIM discharge ≥90 was defined as satisfactory outcome of rehabilitation. Positive correlation was observed between C-MMSE admission and FIM discharge (p< 0.001). There were significant differences in the FIM admission and FIM discharge among the three C-MMSE groups, with lower discharge scores in low C-MMSE groups (p< 0.001). The FIM gain and FIM efficiency during GDH rehabilitation were not different among different C-MMSE groups. C-MMSE admission (p= 0.03) and FIM admission (p< 0.001) were both positive independent predictors for a satisfactory rehabilitation outcomes (FIM discharge ≥90). Cognitive function was not associated with FIM gain and efficiency. This suggested that selected patients with impaired cognition could still benefit from GDH rehabilitation. © 2010 Elsevier Ireland Ltd.

Luk J.K.H.,Fung Yiu King Hospital | Chan T.Y.,Kwong Wah Hospital | Chan D.K.Y.,University of New South Wales | Chan D.K.Y.,Bankstown Hospital
Hong Kong Medical Journal | Year: 2015

Falls are a common problem in the elderly. A common error in their management is that injury from the fall is treated, without finding its cause. Thus a proactive approach is important to screen for the likelihood of fall in the elderly. Fall assessment usually includes a focused history and a targeted examination. Timed up-and-go test can be performed quickly and is able to predict the likelihood of fall. Evidence-based fall prevention interventions include multi-component group or home-based exercises, participation in Tai Chi, environmental modifications, medication review, management of foot and footwear problems, vitamin D supplementation, and management of cardiovascular problems. If possible, these are best implemented in the form of multifactorial intervention. Bone health enhancement for residential care home residents and appropriate community patients, and prescription of hip protectors for residential care home residents are also recommended. Multifactorial intervention may also be useful in a hospital and residential care home setting. Use of physical restraints is not recommended for fall prevention. © 2015, Hong Kong Academy of Medicine Press. All rights reserved.

Chan T.C.,Fung Yiu King Hospital | Chan T.C.,University of Hong Kong | Shea Y.F.,Fung Yiu King Hospital | Shea Y.F.,University of Hong Kong | And 3 more authors.
Journal of the American Medical Directors Association | Year: 2013

Objective: To investigate the strength of association between impaired functional status and long-term (3-year) mortality in Chinese nursing home older adults. Design: A 3-year prospective multicenter cohort study. Setting: Nine nursing homes in Hong Kong. Participants: A total of 672 nursing home older adults (224 men; 448 women), mean age 85.0 ± 7.4. Measurements: Functional statuses of participants were assessed by Barthel Index (BI) and participants were stratified into different groups according to their BI score: BI score 100, BI score 75-95, BI score 45-70, BI score 15-40, and BI score 0-10. Other covariates included age, sex, comorbidities, score of abbreviated mental test, serum albumin, serum creatinine, serum hemoglobin, and hospitalization in the preceding year. The outcome measures were the 1-year, 2-year, and 3-year all-cause mortality. Results: Older adults with lower BI score had significantly higher all-cause mortality and this trend persisted in 1-year, 2-year, and 3-year mortality (P < .001). After multivariate analysis, there was a dose-response relationship in hazard ratio (HR) between BI score and 3-year all-cause mortality (compared with BI score 100; BI score 75-95: HR 1.38 [CI: 1.00-2.56; P < .05]; BI score 45-70: HR 1.80 [CI: 1.04-3.11; P < .001]; BI score 15-40: HR 2.12 [1.21-3.70; P < .001]; BI score 0-10: HR 3.13 [1.82-5.41; P < .001]; and trend test P < .05). Similar relationships were found in 1-year and 2-year mortality. Conclusion: Impaired functional status is associated with higher short-term and long-term mortality with a dose-response relationship in Chinese nursing home older adults. © 2013 American Medical Directors Association, Inc.

Luk J.K.H.,Fung Yiu King Hospital | Tsang R.C.C.,MacLehose Medical Rehabilitation Center | Leung H.B.,Queen Mary Hospital
Hong Kong Medical Journal | Year: 2014

The pathogenesis and management of lateral epicondylalgia, or tennis elbow, a common ailment affecting middle-aged subjects of both genders continue to provoke controversy. Currently it is thought to be due to local tendon pathology, pain system changes, and motor system impairment. Its diagnosis is usually clinical, based on a classical history, as well as symptoms and signs. In selected cases, additional imaging (X-rays, ultrasound, and magnetic resonance imaging) can help to confirm the diagnosis. Different treatment modalities have been described, including the use of orthotics, nonsteroidal anti-inflammatory drugs, steroid injections, topical glyceryl trinitrate, exercise therapy, manual therapy, ultrasound therapy, laser therapy, extracorporeal shockwave therapy, acupuncture, taping, platelet-rich plasma injections, hyaluronan gel injections, botulinum toxin injections, and surgery. Nevertheless, evidence to select the besttreatment is lacking and the choice of therapy depends on the experience of the management team, availability of the equipment and expertise, and patient response. This article provides a snapshot of current medical practice for lateral epicondylalgia management.

Luk J.K.H.,Fung Yiu King Hospital
Hong Kong Medical Journal | Year: 2012

Functional decline is common among older patients during or even prior to hospitalisation, in spite of treatment of acute illnesses. An effective rehabilitation programme is vital to improve the motor and functional states of the older patients. Knowing factors affecting rehabilitation of older persons is important for their effective and efficient rehabilitation. This article, with special reference to local studies, examines age, gender, cognitive function, and serum albumin levels as to how they influence rehabilitation in the elderly. The conclusion is that we should not exclude patients of advanced age from rehabilitation programmes, based on poor cognitive function and low serum albumin levels as they can achieve similar gains in motor and functional outcomes. A nutritional programme to improve the albumin level of older persons could speed up the rehabilitation progress, rendering it more efficient. A genderspecific rehabilitation programme is needed to improve functional outcome in men and motor outcome in women. Moreover, knowing the factors influencing residential care home placement affords an opportunity to reduce reliance on institutionalisation after rehabilitation.

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