The Hong Kong Council of Social Service
Report of
19th IAGG World Congress of Gerontology and Geriatrics
(5-9 July, 2009; Paris, France)
Prepared by Delegation:
Ms. Grace Chan, Man-yee
(Chief Officer (Elderly Service), the Hong Kong Council of Social Service)
Ms. Alice Chiu, Dick-wah
(Association Officer, Hong Kong Association of Gerontology)
Ms. Josie SHEK, Sin-yi
(Social Worker, H.K. Chinese Women’s Club Madam Wong Chan Sook Ying Memorial Care & Attention Home for the Aged)
July 2009
I Background:
Organizer: International Association of Gerontology and Geriatrics
Date: 5th Jul- 9th Jul 2009
Venue: Paris, France
The mission of the International Association of Gerontology and Geriatrics is to promote the highest levels of achievement of gerontological research and training worldwide, and to interact with other international, inter-governmental, and non-governmental organizations in the promotion of gerontological interests globally and on behalf of its member associations. The Association pursues these activities with a view of promoting the highest quality of life and well being of all people as they experience ageing at individual and societal levels.
It was the first time that the IAGG had their World Congress of Gerontologyand Geriatrics in Paris, although it was one of the founding members of the IAGG. The organizer proudly announced that the figures of the first IAGG Congress in 1950 inBelgium, where 113 registrants from 14 different countries were reported. In this 19th Congress which is nearly 60 years later, a total of 5793 participants were recorded from 91 countries attended the event. It was a remarkable development of the organization and the Congress.
It was an important occasion to bring together a worldwide community of researchers, people involved in planning and providingservices and those working in the frontline of gerontology and geriatrics. A total of 3867 presenters introduced 3695 posters, 803 symposia and 288 oral communications, 63 industrial sessions, 10 keynote lectures, 5 late breaking news and 3 workshops.
The Congress’ theme “Longevity, Health and Wealth” was a reminder that an overall view is critical to manage the challenge of ageing. The multidisciplinary approach and issues brings continuous progress that will then ensure the enhancement of seniors’ quality of life.
The presenters came from all regions of the world, including Europe, Asia/ Oceania, North and South America, Middle East and Africa. They exchanged service ideas, shared their research findings from their works and examined new field of research.
In the Congress, it was found that most of the sessions were related to health Sciences and geriatric medicine. One fourth of the sessions concerned social research, policy and practice. The event is the success of those who are committed in many ways with medical and social interface. An attractive program was created and featured the 4 main investigation areas:
- Health and geriatric sciences
- Social gerontology
- Behavioral and psychological sciences
- Biology of ageing
For biological sciences, the communications are focused on mechanisms of ageing, geriatric medicine, frailty, osteoporosis, Alzheimer’s disease, nutrition, and nursing home care. Concerning psychological and behavioral sciences included psychological aspects of ageing, behavioral disorders, and socialgerontology, integrated models of care and social welfare and policy.
The list of keynote is listed:-
- Keynote lecture: Place of sarcopenia in the frailty syndrome
Pr. Luigi FERRUCCI
National Institute on Aging (NIH), United States - Keynote lecture: Clinical practice in nursing homes as a tool for progress
Pr. John E. MORLEY
Saint Louis University (United States) - Keynote lecture: Longevity, health and wealth
Pr. Robert N. BUTLER
International Longevity Center USA (United States) - Keynote lecture: An urgent need to improve life conditions of seniors
Dr. Réjean HEBERT
Health and Social Services Centre – Sherbrooke University Geriatrics Institute (Canada) - Keynote lecture: Critical reflections on families of older adults
Ms. Norah Keating
University of Alberta (Canada) - Keynote lecture: State of the art in a trial fibrillation management in the elderly
Pr. John E. CAMM
St. George’s Hospital Medical School (United Kingdom) - Keynote lecture: Alzheimer disease new finding from ADNI
Pr. Michael WEINER
Center for Imaging of Neurodegenerative Disease (United States)
II Observation, Insight and Recommendation to Hong Kong
1 Role of Sleep in Ageing Process
When we age,our Circadian sleep pattern changes, but it does not relate to sleep problem. Some age related changes in sleep quality, quantity and rhythms may induce the elderly complaints of difficulty in initiating and maintaining sleep, early-morning awakening, unrefreshing sleep and daytime sleepiness. Many research have findings of gradual decrease in the length of stage 3 and stage 4 (delta sleep) and increase in stage 1 and 2 (light sleep). In addition, sleep efficiency progressively decreases and the propensity for daytime napping increases. There appears to be a progressive advance in sleep/wake times with aging, related to a gradual phrase advance in the internal biological clock, this may be the reason to the common complaint of elderly of falling asleep early in the evening and waking up much earlier than desired in the morning and cannot fall back to sleep easily.
Observation
Quality sleeping is vital to maintain health through the ageing process. Learning, memory and other higher cognitive function are influenced by the sleep. Different speakers submit findings of strong relationship between sleep disorders and serious medical problems in older adults. Hypertension, depression, chronic pain, cardiovascular disease and cerebral vascular disease are examples of diseases that are likely to develop in elderly with sleep disorders.
Sleep disorders such as insomnia, sleep apnea, restless legs syndrome, circadian rhythm sleep disorders are commonly found in older persons. Prevalence of sleep apnea increases with age and it is associated with cardiac disease, cognitive and behavioral disorders and impaired quality of life of the elderly. Elderly with sleep disorder have high healthcare utilization due to co-morbidity and use of psychoactive medication. Thus, inquiring about older persons’ sleep on a regular basis in clinical practice is important both for quality of life and longevity and also be referring to when treating sleep problems.
Many speakers have found that sleep disorders in demented elderly are more severe especially the disturbances of the circadian rhythm including noctural sleep disruption and daytime sleepiness. Sleep studies discovered that such disorders are attributable to multiple reasons such as biological reason and environment factors. The melatonin hormone is involved in the regulation of circadian rhythms. Its secretion is early impaired in dementia and is related to delirium, agitation and sleep/wake disturbances and to the severity of the cognitive decline. Sleep disorders increase with the severity of the cognitive impairment and could be a component of the agitation seen in demented elderly.
Other studies have shown that in nursing home, elderly rarely sleep well throughout the day and night, resulting not only in sleep fragmentation, but also in wake fragmentation. The neurodegeneration associated with dementia may also result in neurodegeneration within brain regions responsible for the regulation of sleep.Other institutional factors such as less periodic environmental cue, too much time spent in bed resulting in inactivity, too much light and noise at night and not enough bright light during the day and disruptive nursing care activities can all result in poor sleep. These sleep disturbances can often result in daytime sleepiness, nighttime wandering, confusion and agitation.
Insight and Recommendationto Hong Kong
Assessing sleep in aged care must be a priority and deserve more attention. Clinical assessment tools for gerontologist are now available and some of these tools are specifically developed for the elderly with dementia. In addition, we should put more thought on what we are doing in oldage homes now, including the improvement of the external environment of the age homes to avoid light , noise and disruptive nursing care activities at night, incorporation of more activities and bright light during the day.
To improve the external environment setting of the old age home and to change the attitude of the caring staff in order to alert them to avoid disruptive nursing care activities at night should be emphasized. Therefore a change in the caring approach to manage sleep problem is needed. Measures such as training of caring staff keeping quiet at night and when possible perform caring services at day time , arranging more activities and differential the day and night more clearly within the residential setting.
2 Pain Management of Elderly in Residential Home
Pain is a major problem among older persons living in residential homes. There is a need to manage the painwell. Before we can manage the pain well for an older adult, professional staff should develop instruments to assess the pain itself.
Observation
Although pain is a subjective feeling and assessment relies on client’s self report and in severe demented old people, when self report is unavailable, professional staff haveto make inferences about pain based on behavioral observation to manage pain. In some countries, pain management is regulated and inspected and there is guidance on pain identification assessment, care plan implementation and periodic assessment. Also, if failure to comply can result in sanction and reported to public.
Effective pain management in residential homes starts from initial assessment that include verbal and non- verbal. Besides, it is important to use standard assessment tools, involve interdisciplinary assessment, and observeclient’s response of daily activities as well as the medical condition and history. Besides, implementation of care plan for pain management includes identification of etiology, type and severity of pain, needs and target goal as well as periodic monitoring and evaluation.
In addition, for demented elderly pain ismore complex phenomena, without reliable assessment of pain, it is unable to treat pain.It is especially important for the severe demented persons with reduction of facial action. Possible reasons for diminished facial expression in this population include effects of the disease process or medication, apathy, reduced pain perception and consequences of dysfunctional interaction with carers or staff.
Therapies for managing pain involve some environmental modification, cognitive intervention, physical modalities and exercise. All these non-pharmacologic management of pain are recommended to apply first and if ineffective, appropriate to add pharmacology as well as other complementary therapies.
Insight and Recommendationto Hong Kong
It is important to have more concern about the pain management among our elderly who live in residential homes. In addition,there is a lack of attention for thorough assessments for older persons newly admitted to elderly homes especially for the demented. Most residential home have little concern about the reasons of pain because many have stereotypedthat most elder persons have pain and already have pharmacology treatment. Therefore, improvement of the pain management should be emphasized on reliable assessment and conduct more training and workshop within residential aged homein order to raise the awareness of pain management amongst different levels of staff to cara normal cognitive older persons and demented persons. In addition, organization should set up system to review every resident regularly, standardizeassessment, use accepted protocols, individualize plans, monitor and evaluate success.
3 Palliative Care in Geriatrics
Around half a million people die in England each year, of whom almost two thirds are aged over 75. The large majority of deaths at the start of the 21st century follow a period of chronic illness such as heart disease, cancer, stroke, chronic respiratory disease, neurological disease or dementia. Most deaths (58%) occur in NHS hospitals. With around 18% occurring at home, 17% in care homes, 4% in hospices and 3% elsewhere.
Observation
The NHS End of Life Program(2004-2007), which has contributed significantly to the rollout of programs such as the Gold Standards Framework (GSF), Liverpool Care Pathway for the Dying Patient (LCP) and the Preferred Priorities for Care(PPC).
In UK population 60,975,000, 59,400 people over the age of 75 yrs live/ die in care homes across England ( national Audit office 2008) 25% care home deaths occurred in hospital (NAO 2008).The University of Birmingham evaluation of Phase 2 of the GSFCH Program showed that considerable improvements were made in the quality of care provided and that fewer residents were admitted to hospital in crises (reduced by 12%) and fewer died in hospital (reduced by 8%).
Preferred priorities of Care aims o improve the quality of care at the end of life for all patients and enable more patients to live and die in the place of their choice.
“Improving care in the last year of life to the level of the best”
Insight and Recommendationto Hong Kong
When dementia patients in NHs develop pneumonia, referral frequencies to hospitals are much higher. However, palliative care saves money when avoiding care intensive in ICU. Two out of third dying in NHs especially dementia over 98%in Netherland. However, the percentage in HK is almost 0%.
In addition, feedback from staff at the workshops and 'speed-dating' sessions, consultation with colleagues and the guidance of the steering group confirmed that there are many perceived improvements in quality and coordination of care of residents, in proactive planning, discussion of Advance Care Planning, involvement of families, improved collaboration with GPs and Specialist Palliative Care Teams and the better staff satisfaction, liftingmorale and confidence, leading to greater levels of staff retention.
More importantly, the promotion of advance directive and enduring power of attorney should increase in order to promote the palliative care in nursing home.
Caring for those approaching the end of life is one of the most important and rewarding areas of care. Although it is challenging and emotionally demanding, if staff has the necessary knowledge, skills and attitudes, it can also be immensely satisfying.
However many health and social care staff have had insufficient training in identifying those who are approaching the end of life, in communicating with them or in delivering optimal care. To address this, a major workforce development initiative is now needed, with particular emphasis on staff for which end of life care is only one aspect of their work. This will include the provision g communications shills training programs and other programs.
4 Gerontechnology
Observation
There are two examples of gerontechnology. The first one is Blue-green light. Behavioral and psychological symptoms expressed at higher rates in Alzheimer’s disease. Disturbed sleep-wake rhythms increase, the reversal of day-night patterns, the increase stress and burden for the caregiver and patient.
When the Morning blue-green light via cap visor, the significant increase in sleep efficiency, sleep efficiency remained above baseline through end of study and demonstrated significantly reduced Excessive Daytime Sleepiness at all meal times post-intervention.
The caregiver perceptions six cognitive changes, namely wake and alert, verbal competence, recognition and recollection, motor coordination, psychosocial changes, recaptured personality, environmental engagement and improved mood.
Light visors seem to have potential as a safe and manageable light delivery method
Therapeutic light may have potential to lengthen time of function independence, improve quality of life, delay institutionalization, and compress morbidity at the end of life. However, the sample size is too small only 11 cases.
The second example isdiaper for incontinence. The 3DI project: Device for the Dignity of the Disabled Incontinent provides cost-effective, automated, repaid, and comfortable cleaning each time it is needed, without the help of a carer.
The device consists of there parts: a short trouser opening between the things of the patient, a latex- or polymer- made disposable cup- shaped bag that receive urine and feces, a detector that senses when the bag requires cleaning and initiates the cleaning process. The cleaning process involves automated cleaning of the patient’s perineum with water and gentle drying, before the application of a thin layer of oil on the skin of the patient.
Experiences that are relevant or insightful to Hong Kong
If home technologies are to be successful in supporting independence of older people, they should be designed with the needs of older people in mind.
Technology helps to increase the independency, dignity, more interactive, release the pressure of carers and provide the atmosphere for the people to stay in the communities.
Insight and Recommendationto Hong Kong
Not only gerontology is a multidisciplinary field, also technology is multidisciplinary in its own. Technologies have different origins and standards. A multidisciplinary approach is lacking.