Community Foot Care Service: A Pioneer Multi-disciplinary Partnership Program for Elderly Foot Care Patrick NG BSc(Hons) MMedSc Podiatrist-in-charge St. James’ Settlement Symposium on Community Engagement II 23 September, 2006

Background Foot problems are affecting one in three community- dwelling elderly (Barr et. al., 2004), and associated with poor mobility, increased frequency of fall, and functional deterioration in elderly (Dawson et. al, 2002). Elderly considers foot pain an inevitable consequence of aging rather than a medical problem (Menz & Lord, 2001). Garrow et al. (2004) reported 84% of patients neglect the foot problem. Chinese population exhibits a higher threshold of perception of symptoms of foot condition (Chan & Chong, 2002).

Bound Feet

Ambulation may be the only dividing line between institutionalisation and remaining an active member of the society.

Hidden Bombs

Community Foot Care Service A pilot project - the collaboration between St. James’ Settlement and Hong Kong East Clusters’ hospitals. Focus on enhancing foot care to the poor and socially deprived elderly, who is unable to take care of their own foot health.

Objectives To provide accessible podiatric care to the community dwelling home or institute bound elderly. To maintain post hospital discharged high risk patients and minimises unplanned readmission and ulcer recurrence rate. To reduce the demand on HA hospital podiatry service.

Community Referrals HKEC Hospitals for podiatric care Prevention Maintenance Community Foot Care Team Algorithm of Referral Exacerbated Discharge acute and subacute foot diseases When high risk foot stabilised then discharge. chronic foot problem for palliative care

Sources of Referrals

Old Age Home Foot Profile (1)

Old Age Home Foot Profile (2) Other findings % Improper caring of toe nails 64 Foot problem result from neglected self foot care 41

Case Illustration I Knee extension padding F/84, renal impairment, dementia & CVA with R hemi

Case Illustration II Pressure Sore on Lateral Malleolus of Right Foot Special design for Malleolus Protector

Highlights of the Program Strength: being mobile and out-reaching, provides on-site team approached foot management. Limitation: only 1 podiatrist and 0.5 PT & 0.5 OT to provide service. Future development: the same service model could roll out to other clusters if resources is available. Sustainability: this program is supported by a charity donation, a long term commitment is essential.

Conclusions This pilot program is an example of hospital-community and multi-disciplinary collaboration. The Community Foot Care Service has improved the general foot condition of the institutional bound elderly by increased accessibility to podiatric care, one-stop multi- disciplinary referral, and shortened waiting time. Prevention and maintenance of chronic medical conditions in the community are relatively low cost but can contribute significantly towards the reduction of overall health care expanses. More emphasis and attention as well as resources should be available at the community level to promote early prevention and care, in view of our aging society.

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