Organised by: Co-Sponsored: Malaysian Healthy Ageing Society
Multi-Discipline Collaboration Bridging The Gap Between Primary And Secondary Care - Occupational Therapy (OT) Perspective 20 March 2012 (1 st World Congress On Healthy ageing) Thillainathan Krishnan • BSc. (Hons) Applied Rehabilitation (Occupational Therapy) UK, • Dip. In Occupational Therapy (Mal), • Post Basic in Occupational Health and Safety (MOH, MAL), • Cert. in CBR (JICA/JIMTEF)] • Head of Occupational Therapy department • SELAYANG HOSPITAL
Primary Health Care facility Secondary Care (Health Clinic) (Hospital)
Overview Of The Presentation • OT History • Current Concepts of Healthy Ageing / Scenario • OT’s Role in primary and Secondary care • Efforts to Bridging The Gap • Challenges and possible solutions
THE CULTURE OF HEALTHY AGING: • Healthy aging has been a very important agenda for many health care providers as much as there is an enormous demand from Clients (as the service user) worldwide. The main aims of promoting healthy aging are to keep people more active and function independently (Kyriakidou 1992).
Definition of Healthy Ageing: • “Healthy ageing is the process of optimizing opportunities for physical, social and mental health to enable older people to take an active part in society without discrimination and to enjoy an independent and good quality of life”
• many research activities about maintaining general health and well-being throughout the aging process have proved that people who are concerned about their aging have better life satisfaction towards the end-of- life phase. • The same pattern can also be seen in other nations of the world and this is inclusive Malaysia.
OBJECTIVE • Malaysian Health Policy : - Nation of healthy individuals, families & community . -Through equitable, affordable, efficient, technologically appropriate, environmentally adaptable & consumer friendly health system. -Emphasis on quality, innovation, health promotion & respect for human dignity. -Promotes individual responsibility & community participation.
GOALS OF HEALTH CARE SYSTEM • Wellness Focus • Person Focus • Informed Person • Self Help • Care Provided At Home Or Close To Home • Seamless, Continuous Care • Services Tailored To Individual Or Group Need • Effective, Efficient And Affordable Services
Current Statistics (MOH): • 135 - Hospitals • 50 - 1 Malaysia clinics • 2815 health clinics • >800 OT’s in Hospitals (Health) • 52 OT’s in KK (Health) • OT’s in Community - 12(welfare) (Source: Portal MyHealth)
OCCUPATIONAL THERAPY : • Rehabilitating a person to a total / maximum well being through selected functional activity to enable the person to be independent & return back to his/her community
OCCUPATIONAL THERAPY CONTRIBUTION TO HEALTH CARE : (Primary and secondary Care) - To prevent disability, to improve health, achieve optimum function and independence & enhancing quality of of life. (minimize the effect of losses & compensate the deficits, support their competencies & maintain self esteem)
ROLES OF OCCUPATIONAL THERAPY : • Prevention of disease or illness • To assess & rehabilitate functional disability • To assess needs of aids / gadgets and modifications • To improve the quality of life
OCCUPATIONAL THERAPIST • One of the Most important Health Care Professional in Multi- Disciplinary Team collaboration to rehabilitate a person to optimal wellbeing health status.
Conditions : • Pediatrics • Medical • Neurology • Palliative • Orthopedic • Oncology • Surgical • Hand and • Psychiatric Microsurgery • Spinal • Child Psychiatry
Common Problems In Primary Care: (Health Profile) • Edema • Diabetis • Vertigo • Central nervous system: • Anemia - Dementia,depression, • Hypo tension cerebrovascular disorder, parkinson, • Metabolic disturbances • Cataract - electrolite disturbances, • Hypertension hypoglycemia • Musculosceletal • Delirium disorders • Incontinence - Arthritis, muscle weakness
Why Occupational Therapist? • Occupational Therapist have a great deal to offer to ageing person because we belief that everyone , in spite of illness or disability, can be helped through their own action to reach the highest level of independence and ability that is possible for them
OT Competencies • We assess each individual, thinking always towards recovery not only physical but also aware of the psychosocial problems they have
SCOPES OF OT INTERVENTION • Conditions and interventions in care of an ageing person quite unique considering humans operate as occupational beings who deal with major changes in various aspects of biological/physical, emotional, social, psychological, cognitive and perceptual, psychosocial in their daily living (ADL), work/productivity and leisure activities (Crepeau et al. 2003)
scopes of interventions by OT’s can be split into two big groups of domains: i) Physical – mainly covers areas concerned with physical dysfunction that forbid clients from being independent in previous routine/function. ii) Mental Health – mainly covers areas concerned with mental disability of both neurosis and psychosis which prevents clients from engaging independently in areas of previous level of performance.
Functional Domain : • Physical ADL / Everyday ADL : - Self care & personal hygiene(Bathing, dressing, using toilet, eating, drinking, walking, transfer) • Instrumental ADL: - Related to home management( Shopping, prepare meal, money management, using phone)
History of OT in Malaysia: • 1 st OT working in Sungai Buloh Leprosy Center (in late 1950’s) • Pioneer OT’s working in mental Institutions (1960’s). • More OT’s Working in General Hospitals (1970’s) • OT’s working in Community and OT training started locally (1980’s) • OT’s working in district Hospitals and specialized areas and Private practice (1990’s) • OT’s working in health clinics (20 th Century)
Advantages : • OT training (Education Program) includes community placement. • OT’s work in terms of context where the client lives (environment and culture) • OT’s are ‘ enablers ’ -creative and flexible with critical and analytical thinking. • OT scope includes home/environmental assessment and modification recommendation.
Principle Of Rehabilitation: ICF(2001) • Activity : The performance • Health condition : A of a task by an individual disorder or disease affecting the individual • Participation : An • Body function/structure individual’s involvement in life situations in relation to : The physiological or health conditions, body psychological functions functions and structure , activities and contextual of body systems factors
Types Of Rehabilitation: • Preventive Rehab. • Educational Rehab. • Vocational Rehab. • Social Rehab.- ability of a person to function in various social situations towards the satisfaction of his/her needs & the right to achieve maximum richness in his/her participation in the society. • Acute Rehab. • Medical Rehab.
Rehabilitation In Health Centers: • Primary Rehab. • Concept Of Community Based Rehabilitation (CBR) : -Community & client centered -Focused on prevention & early detection -Promotes consumer participation -transparent & information sharing -Consistent & flexible -Rehab. Carried out in clients on surrounding
Referral System in Health Clinics: Family Communit y HOSPITAL Instituitions NGO MDT Health Clinics SELF REFERRAL OT’S
Global direction: • Internationally, nations has been urged to develop, implement and evaluate policies and programs to promote healthy and active ageing. • It suggests for new multi-sectoral partnerships with intergovernmental, private sector and voluntary organizations. • Occupational Therapy in ‘ new Direction ’
According to the WHO: • Chronic diseases ( Lifestyle issues / noncommunicable diseases ) is by far the leading cause of mortality in the world, representing over 60 % of all deaths -(By2030, deaths from chronic diseases are expected to increase to 52 million per year) • Deaths caused by infectious diseases, maternal and perinatal conditions and nutritional deficiencies are expected to decline by seven million per year during the same period
A HOLISTIC VIEW OF WELLNESS: • Holistic concept of Wellness includes the involvement of one’s “ Physical, Social, Emotional, Occupational, Spiritual and Intellectual ” • “the state of being healthy” and as “…an active process by which an individual progresses towards maximum potential possible, regardless of current state of health ” -Travis and Ryan (1988), Hornby (2005), Anon (2006)
Good news! • It is interesting to note that risk factors such as a person’s background, lifestyle and environment are known to increase the likelihood of chronic diseases , which means we have an opportunity to intervene by treating the cause and not the illness exclusively.
Unfortunately! • Roles of OT in different set-up not efficiently coordinated • OT’s role in Health Clinics mainly on preventive medicine only • Majority of the OT’s in Primary Care are rendering their services to Community based rehabilitation which comes under Social Welfare ministry
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