Chronic conditions - Hypertension, Diabetes Mellitus, Hyperlipidemia, Heart Diseases, COPD Health risks - Elevated Blood Pressure/ Glucose, Central Obesity or Chronic pain =5 Not Applicable
Conditions
Interventions
The study is a 12-week interventional, multicenter, a multi-arm multi-stage trial, aimed at understand the effect of two interventions: 1) Health coaching for pre-frail community-dwelling elderly
and 2) Nurse-led program for frail community-dwelling elderly, for the effectiveness on managing participants’ chronic conditions and health risks.
All participants (including all con
Elderly with risk of impaired cognitive function (with a Mini-Cog score of 2 or below), and/or with high fall risk (with a Tinetti Poma score 18 or below), and/or with a diagnosis of dementia or cogni
Sponsors
City University of Hong Kong
Eligibility
Sex/Gender
All
Inclusion criteria
Inclusion criteria: 1. Aged 60 or above 2. Referred by collaborating NGOs, existing service users of (i) Support Team for Elderly or (ii) Integrated Homecare Services (Ordinary Case) 3. Residing in the following areas of Hong Kong – Kowloon (i) Yau Tsim Mong (ii) Sham Shui Po (iii) Homantin 4. Living at home before and after discharged from hospital 5. Communicate in Cantonese, Mandarin or English 6. No active psychiatric syndromes 7. At least one of the following health conditions: 7.1. Hypertension 7.2. Diabetes Mellitus 7.3. Hyperlipidemia 7.4. Heart Diseases 7.5. COPD 7.6. Elevated Blood Pressure / Glucose 7.7. Central Obesity 7.8. Chronic Pain
Exclusion criteria
Exclusion criteria: 1. Aged 59 or below 2. Residing outside the designated areas and non-collaborating NGOs service users 3. Having no chronic conditions or health risks as listed in “Inclusion criteria” 4. Adverse Home Environment: Woodlouse, severe hygienic problem 5. Unstable mental conditions: Violent tendency, Paranoid delusion, etc 6. Communication problems: Language other than Cantonese, Mandarin, or English; Severe hearing problem which cannot be corrected by hearing aids
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| Measured at baseline, post intervention (3-4 months), and follow up (6-7 months): 1. Blood pressure (mmHg) 2. Blood glucose 3. BMI (kg/m²) 4. Waist circumference (cm) 5. Self-care functioning measured with Barthel Index for Activities of Daily Living (ADL) and The Lawton Instrumental Activities of Daily Living Scale (IADL) 6. Cognitive Functioning was measured with Mini-Cog 7. Fall Risk was measured by Tinetti Performance-Oriented Mobility Assessment (POMA) 8. Physical activities was measured by The Chinese Version of the Physical Activity Scale for the Elderly (PASE-C) 9. Quality of life was measured by EQ-5D-5L (Traditional Chinese Version for Hong Kong) 10. Self-efficacy was measured by General Self-efficacy Scale - C (GSE-C) 11. Medical service utilization were measured by hospitalization, readmission, length of stay, ER visits for the past 3 months | — |
Secondary
| Measure | Time frame |
|---|---|
| There are no secondary outcome measures | — |
Countries
Hong Kong
Outcome results
None listed