Authors: (including presenting author): :
Sit LK (1), Cheung KW (1), Po TF (1), Hui N (1), Chan SFR (2), Chu WY (2), Yeung SY (2)
Affiliation: :
(1) Occupational Therapy Department (OTD.), United Christian Hospital (UCH), (2) Health Resource Centre (HRC) , United Christian Hospital (UCH)
Keyword 1: :
Home-based rehabilitation
Keyword 2: :
Cognitive Rehabilitation
Keyword 4: :
Medical-Social Collaboration
Keyword 5: :
Occupational Therapy
Introduction: :
Cognitive Rehabilitation has been proven effective extensively in decades for the cognitively impaired. With emerging modalities involving advanced technologies such as virtual reality, cognitive training has become appealing to many. Yet, for the underprivileged including alone elderly or double-aging elderly families, their low educational backgrounds and poor social support led to low digital literacy (Cho et. al, 2025), hindering their access to eHealth technologies and motivation to innovative cognitive training, not to mention the transportation barriers to rehab facilities. Therefore, delivery of traditional cognitive rehabilitation program is still vital. However, owing to manpower tightness and heavy existing workload of occupational therapists, provision of intensive, home-based cognitive training may not be operationally feasible. Therefore, UCH OTD. has collaborated with HRC launching Volunteer-led Home-Based Cognitively Active Lifestyle Program (VCAL@ Home) since 2015. Individualized cognitive stimulation programs were conducted by volunteers with OT’s guidance in patient’s home environment.
Objectives: :
The study aimed to review effectiveness of VCAL@Home on improving patient’s cognitive functions, well-being and relieving caregiver stress.
Methodology: :
The program has launched with ongoing data collection since 2015. Inclusion criteria were namely: 1. Diagnosed/Suspected with mild cognitive impairment (MCI) or dementia, 2. Poor social support (i.e., alone/ double-aging families/ day-time alone etc.) and 3. Willing to receive home visits. HRC assisted in volunteer recruitment from different service partners of NGOs in the community. OTD and HRC provided workshops in equipping volunteers with clinical-related knowledge and skills in implementing home cognitive stimulation programs before home visit commencement. 6-to-10 training sessions were offered including Reality Orientation, Cognitive Stimulation Programs and Health Qigong by volunteers. OT/HRC Social worker (SW) provided joint initial visit with volunteers to ensure accurate training delivery while SW provided interim support visits with volunteers. Pre-post outcome evaluations included Montreal Cognitive Assessment Hong Kong Version Five Minute Protocol (HK-MoCA 5-min), World Health Organization-Five Well-Being Index (WHO-5) and Caregiver Strain Index (CSI), along with social support evaluation and satisfaction survey to both patients/caregivers.
Result & Outcome: :
Total 83 cases were recruited, with 71 completed. Regarding the demographics of completed cases, mean age was 84.9, 52.1% were male, 36.7% were either alone or daytime alone, and 55% were ADLs supervised or assisted, demonstrating possible low digital literacy and difficulty in transport arrangement and thus suitability for the program. Pre-post outcome evaluation analysis showed both cognitive (improved in HK-MoCA 5-min: p = .002 < 0.05) and well-being aspects (improved in WHO-5: p < .001) improved while caregiver stress was reduced (Reduction in CSI: p = .0047 < 0.05) with statistically significant effect using Wilcoxon Signed-Rank test. Both patient and caregiver social support evaluation survey showed significant improvement (Patient: p=0.002; Caregiver: p < 0.001), demonstrating self-perceived increased social support and connectedness to community. The average scores of satisfaction survey for patients and caregivers were 4.56 and 4.21 (out of 5) respectively, showing their high appreciation towards the program. The results showed VCAL@Home has benefited patient's cognitive functions and well-being and reduced caregiver stress, implying that medical-social collaboration can be operationally feasible with volunteer involvement in home-based cognitive rehabilitation programs. Further recruitment of both patients and volunteers should be warranted in view of increasing service need for aging community.
