Impact of a personalised care plan for the elderly calling emergency medical services after a fall at home: The RISING-DOM multi-centre randomised controlled trial protocol.

BACKGROUND: A growing number of emergency calls are made each year for elderly people who fall. Many of them are not taken to hospital or are rapidly discharged from the Emergency Department (ED). Evidence shows that, with no further support, this vulnerable population is particularly at risk of injuries, dependency and death. This study aims to determine the effectiveness of a comprehensive geriatric assessment and a tailored intervention in the elderly calling on an Emergency Medical Service (EMS) for a fall at home, but not conveyed to the ED or rapidly discharged from it (less than 24 h from hospitalisation), to the time to institutionalisation or death. METHODS: Rising-Dom is a two-arm randomised (ratio 1:1), interventional, multi-centre and open study. Community-dwelling elderly people (≥ 70 years) who call an EMS for a fall at home are recruited. The intervention group receives home visits by a nurse with a comprehensive fall risk assessment and a personalised intervention care plan with a planned follow-up (six nurse home visits and five nurse phone calls). Subjects enrolled in the usual care-control group continue to receive their routine care for the prevention or treatment of diseases. Primary (time to institutionalisation or death) and secondary (unscheduled hospitalisations, additional EMS calls relating to falls, functional decline and quality of life) outcome data will be collected for both groups through five phone calls made by Clinical Research Associates (CRA) blind to the participants' group during the follow-up period (24-months). Twelve hospital centres in the South-West of France are participating in the study as study sites. The inclusion period started in October 2019 and will end in March 2022. By the end of this period, 1,190 subjects are expected to be enrolled. DISCUSSION: Studies on elderly home falls have rarely concerned people who were not taken to hospital. The Rising-Dom intervention scheme should enhance understanding of features related to this vulnerable population and investigate the impact of a nurse care at home on delaying death and institutionalisation. TRIAL REGISTRATION: Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. SPONSOR: University Hospital, Toulouse. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1.

[Assessment in the home of the elderly following a first fall with Samu intervention]. / Évaluation au domicile des personnes âgées dans les suites d'une première chute avec intervention du Samu.

The Rising-Dom study is a project to evaluate the impact of home intervention by an experienced geriatric nurse on mortality and institutionalization of older people who fall. It is a multicentre randomised interventional study. The two-year follow-up will compare the evolution of two groups: intervention (assessment by the nurse and proposal of a care plan) vs. usual care (simple information on ageing well and on the prevention of falls at home). First feedback from the field.

[Full support from step 1 to step 5]. / La prise en charge complète du step 1 au step 5.

Comprehensive care from step 1 to step 5 of Integrated Care for Older People programme requires the implementation of a new care pathway. It has to take into account the resources of each territory and to be oriented towards maintaining the capacities of older people.

[Tele-nursing: an innovation in geriatrics]. / Le télésuivi infirmier, une innovation en gériatrie.

The World Health organization programme Integrated Care for Older People involves the long-term monitoring of the many senior citizens who are registered. It is made possible by tele-nursing, but requires new skills for the nursing who implement it.

[Social precariousness and fragility, literature review]. / Précarité sociale et fragilité, revue de littérature.

Today, one of the main areas of prevention of elderly dependency is the care of the most vulnerable people. This one and their identification are part of local prevention. To be effective, this system must go to the very heart of living and meeting places, beyond the traditional reference of vulnerability management in day hospitals or in consultations.

[Healthcare research, a reflexive approach in oncogeriatric]. / La recherche en soins en oncogériatrie.

Healthcare research is developing. The oncogeriatrics team of the Toulouse University Hospital started from an innovative practice to think about a research protocol. It is an evolving, reflexive and complex approach for the caregivers with the hazards of responding to calls for research projects.

[Patients' expectations in a day hospital for frail elderly people]. / Patients et hôpital de jour des fragilités.

The care management of frail elderly people must ensure that patients adhere to their personalised care and prevention plan. In order to optimise this adherence, it is essential to take into account the expectations of these aging population. This article presents the results of an analysis carried out by a nursing team regarding the expectations of patients in a day hospital for frail elderly people.

[Nurse telephone follow-up, a beneficial tool in geriatric oncology]. / Le suivi téléphonique infirmier, un atout en oncogériatrie.

Supporting patients undergoing chemotherapy is one of the priorities of geriatric oncology care. To this effect, a Toulouse hospital team has developed a telephone follow-up service operated by nurse navigators. In collaboration with the multi-disciplinary team of the hospitalisation service, it provides close support to the patient and their family.

[From dependency to autonomy, a geriatric pathway]. / De la dépendance à l'autonomie, un parcours gériatrique.

Preventing dependency is essential in our ageing society. One of its components is the avoidable dependency which develops during a period of hospitalisation. Caregivers play an important role in helping the elderly person regain their autonomy. Various actions have been undertaken on this theme within the gerontology unit of Toulouse university hospital, including the creation of a multi-disciplinary group of experts among the caregivers working in the unit.

[Role of the nurse in the prevention of dependence]. / Rôle de l'infirmière dans la prévention de la dépendance.

Preventing frailty in elderly people to delay their dependency is one of the main missions of the Gérontopôle, a centre of expertise for gerontology, in Toulouse. The proposed actions are simple to put in place and the nurses are autonomous in carrying out assessments. Nursing expertise has also been developed within the centre.

Exploring Population Characteristics and Recruitment Challenges in Older People Experiencing Falls at Home without Hospitalization or with an Emergency Department Visit: Insights from the RISING-DOM Experience.

Background: An increasing number of falls among community-living older adults are reported in emergency calls. Data on evidence of appropriate fall prevention interventions are limited and challenges in recruiting this population in randomized trials are acknowledged. Purpose: The main aim of this study was to provide demographic data, circumstance and fall-related outcomes of the population in the RISING-DOM study [Impact d'une évaluation des facteurs de RISque de chute et d'une prise en charge personnalisée, sur la mortalité et l'institutionnalisation, après INtervention du SAMU chez la personne âGée à DOMicile], a multicenter, randomized interventional trial involving community-dwelling older adults who have experienced a fall at home and were not hospitalized. Additionally, the challenges of remote recruitment in this population were discussed. Patients and Methods: Participants were identified through the Occitania Emergency Observatory database. Participant recruitment and data collection were performed through telephone interviews (October 2019-March 2022). Additionally, a sample survey of Emergency Medical Services calls was carried out. Results: Out of the 1151 individuals screened, a total of 951 participants were included in the trial follow-up, resulting in an acceptance rate of 82.62%. The screening delay was extended due to the COVID-19 pandemic. Recruiting difficulties were mainly related to identifying potential participants, unavailable contact information and unreachability. Participants' mean age was 84.1 years, 65.8% were women, and 44.3% lived alone. Pain was the most frequent outcome (53%). In the previous year, 73.5% of participants reported experiencing a fall, with 66.7% of those falls requiring assistance from Emergency Medical Services (EMS). Nearly, 40% did not take proactive steps to prevent future falls and walking aids (79.8%) were the most common preventive action. Conclusion: Indicators of a high-risk group of falls have been identified underscoring the need for appropriate fall interventions in the target population. Challenges of large sampling for randomized fall prevention trials were provided. Trial Registration: Clinicaltrials.gov identifier: NCT04132544. Registration date: 18/10/2019. https://www.clinicaltrials.gov/ct2/show/NCT04132544?term=rising-dom&draw=2&rank=1.

Implementation of the WHO integrated care for older people (ICOPE) programme in clinical practice: a prospective study.

BACKGROUND: The INSPIRE integrated care for older people (ICOPE)-CARE programme is a public health programme implementing the ICOPE health-care pathway in clinical practice. The primary objective of this study was to describe the large-scale implementation and feasibility of the INSPIRE ICOPE-CARE guidelines in clinical practice. The secondary aims were to describe the characteristics of patients who were identified as positive for abnormalities in intrinsic capacity (ie, locomotion, cognition, psychology, vitality, hearing, and vision) during step 1, and to describe the prevalence of these positive screenings. METHODS: In this prospective study, we evaluated a real-life population of users of primary care services in the Occitania region (France). Participants who were aged 60 years and older and lived in a community were eligible for inclusion in our study. Individuals aged ≥60 years were screened (step 1) by health-care providers or through self-assessments using digital tools (the ICOPE MONITOR app and the ICOPEBOT conversational robot). Our implementation strategy involved raising awareness among health-care professionals about the WHO ICOPE programme, training professionals in the ICOPE-CARE guidelines, and developing a digital infrastructure (ie, digital tools, a database, and a remote ICOPE monitoring platform). The feasibility of implementing the INSPIRE ICOPE-CARE guidelines was determined by the anticipated inclusion of ≥10 000 participants, and having a follow-up rate of over 50%. FINDINGS: Between Jan 1, 2020, and November 18, 2021, 10 903 older people (mean age 76·0, SD 10·5 years; 6627 [60·8%] of whom were women) had a baseline step 1 screening done, and 5185 (70·4%) of 7367 eligible participants had a 6-month follow-up of step 1 screening. 10 285 (94·3%) participants had a positive intrinsic capacity result during screening at baseline. 958 (9·3%) participants were evaluated with step 2 (in-depth assessments). Positive intrinsic capacity was confirmed in 865 (90·3%) participants. Most recommendations in step 3 (care plan) were related to locomotion, vitality, and cognition. INTERPRETATION: The high number of participants included in our study, as well as the high rates of follow-up, provides evidence to suggest that the large-scale implementation of ICOPE in clinical practice is feasible. The very high prevalence of positive screening for impaired intrinsic capacity during step 1, as well as the high rates of confirmed deficits in intrinsic capacity during step 2, suggest that the INSPIRE ICOPE-CARE programme is able to target individuals who are at increased risk for functional loss and disability. FUNDING: Occitania Regional Health Agency, Region Occitanie and Pyrénées-Méditerranée, European Regional Development Fund, and The Interreg Program V-A Spain-France-Andorra.