[COGERIA: coordination of care for the frail elderly]. / COGERIA : Coordination des soins de la personne âgée fragile.

COGERIA, a cantonal program is the fruit of a close collaboration between the Geneva General Directorate of Health and the major health and social partners in the canton. The program aims to improve inter-professional care for the frail elderly and to adapt their care pathways in close collaboration with their primary care physicians and home healthcare providers. Launched in May 2019, the program includes more than 283 beneficiaries and 152 primary care physicians in collaboration with the home healthcare providers in the Servette and Meyrin areas. Preliminary results show a possible trend towards a decrease in hospitalizations, as well as major satisfaction from beneficiaries and the COGERIA partners.

La Coordination des soins de la personne âgée fragile est un dispositif cantonal né d'une étroite collaboration entre la Direction générale de la santé et les grands partenaires de la santé et du social à Genève. Ce dispositif œuvre à améliorer la prise en charge interprofessionnelle autour des personnes âgées fragiles et à adapter leurs parcours de soins, en étroite collaboration avec les médecins traitants et les prestataires de soins à domicile. Lancé en mai 2019, le dispositif compte plus de 283 personnes incluses, avec 152 médecins traitants du réseau primaire en collaboration avec l'Institution genevoise de maintien à domicile, ainsi qu'une ouverture récente à tous les prestataires de soins dans les zones de la Servette et de Meyrin. Des résultats préliminaires mettent en évidence une possible tendance à une baisse d'hospitalisations ainsi qu'une grande satisfaction de la part des bénéficiaires et des partenaires.

Integrated care at home reduces unnecessary hospitalizations of community-dwelling frail older adults: a prospective controlled trial.

BACKGROUND: Care of frail and dependent older adults with multiple chronic conditions is a major challenge for health care systems. The study objective was to test the efficacy of providing integrated care at home to reduce unnecessary hospitalizations, emergency room visits, institutionalization, and mortality in community dwelling frail and dependent older adults. METHODS: A prospective controlled trial was conducted, in real-life clinical practice settings, in a suburban region in Geneva, Switzerland, served by two home visiting nursing service centers. Three hundred and one community-dwelling frail and dependent people over 60 years old were allocated to previously randomized nursing teams into Control (N = 179) and Intervention (N = 122) groups: Controls received usual care by their primary care physician and home visiting nursing services, the Intervention group received an additional home evaluation by a community geriatrics unit with access to a call service and coordinated follow-up. Recruitment began in July 2009, goals were obtained in July 2012, and outcomes assessed until December 2012. Length of follow-up ranged from 5 to 41 months (mean 16.3). Primary outcome measure was the number of hospitalizations. Secondary outcomes were reasons for hospitalizations, the number and reason of emergency room visits, institutionalization, death, and place of death. RESULTS: The number of hospitalizations did not differ between groups however, the intervention led to lower cumulative incidence for the first hospitalization after the first year of follow-up (69.8%, CI 59.9 to 79.6 versus 87 · 6%, CI 78 · 2 to 97 · 0; p = .01). Secondary outcomes showed that the intervention compared to the control group had less frequent unnecessary hospitalizations (4.1% versus 11.7%, p = .03), lower cumulative incidence for the first emergency room visit, 8.3%, CI 2.6 to 13.9 versus 23.2%, CI 13.1 to 33.3; p = .01), and death occurred more frequently at home (44.4 versus 14.7%; p = .04). No significant differences were found for institutionalization and mortality. CONCLUSIONS: Integrated care that included a home visiting multidisciplinary geriatric team significantly reduced unnecessary hospitalizations, emergency room visits and allowed more patients to die at home. It is an effective tool to improve coordination and access to care for frail and dependent older adults. TRIAL REGISTRATION: Clinical Trials.gov Identifier: NCT02084108 . Retrospectively registered on March 10th 2014.

[Identification of elderly material and financial abuse]. / Comment dépister les abus matériels et financiers envers les personnes agées?

Elder abuse and in particular material and financial exploitation involving the misappropriation of the older person's money or property is common but rarely identified or managed in clinical practice. It has a direct impact on quality of life, health and social status. Our aim is to assist clinicians by summarizing this frequently unrecognized problem. We discuss risk factors, alerting signs, clinical manifestations, and specific questions that can be used for screening purposes as well as intervention strategies preferably in the context of a multidisciplinary team.

Factors associated with caregivers' underestimation of quality of life in patients with Alzheimer's disease.

OBJECTIVE: The aim of this study was to identify the factors associated with differences between how Alzheimer's disease (AD) patients and their caregivers rate the patient's health-related quality of life (QoL). METHODS: Cross-sectional, multicentre study. Patients were 65 years or more, suffering from mild to moderate AD, native French speakers, with a main caregiver. Interrater agreement of the QoL-AD was assessed using the intraclass coefficient. A generalised linear model was used to identify factors related to the difference in health-related QoL scores between patients and their caregivers. RESULTS: The 122 patients of the study were 82 ± 6 years old and mainly women (69%). Independent factors related to the difference between patients and caregivers were: Mini Mental State Exam score (ß = 0.32; 95% CI = 0.05-0.59); instrumental activities of daily living score (ß = -0.61; 95% CI = -1.14 to -0.07); total Neuropsychiatric Inventory score (ß = 0.10; 95% CI = 0.05-0.59), and Zarit's burden score (ß = 0.09; 95% CI = 0.01-0.17). CONCLUSION: Practitioners must take into account the trend towards underestimation when health-related QoL is rated by caregivers or proxies.

[Collaboration between the primary care physician and the occupational therapist]. / Collaboration entre le médecin de premier recours et l'ergothérapeute.

If the collaboration with nurses and physical therapists is frequent for primary care physicians, it is not the case with occupational therapists. This article will describe and contribute to develop interactions between primary care physicians and occupational therapists in the outpatient and home care settings. We will explore the indications for referral to occupational therapy, available techniques and the best appropriate ways to prescribe it.

[General internal medicine: important articles about ambulatory care published in 2010]. / Médecine interne générale: articles importants pour la pratique ambulatoire en 2010.

This review of articles published in 2010 covers the new role of dabigatran in atrial fibrillation, the lack of efficacy on pain of chondroïtine/ glucosamine in knee arthrosis, the risk of thrombosis with antipsychotics, the increase cardiovascular risk in case of migraine with aura and the insufficient prescription of adjuvant chemotherapy in elderly with colon cancer. Authors also highlight public health topics such as the association of poor oral hygiene and increased cardiovascular risk, the positive effect of opioid substitution therapy by primary care practitioners on mortality, the high frequency of prenatal violence on pregnant women and the negative impact of financial constraint on the risk of hospitalization.

Transcultural adaptation and psychometric validation of a French-language version of the QoL-AD.

OBJECTIVES: The aim of this study was to assess the psychometric properties and the transcultural adaptation into French of the quality-of-life in Alzheimer's disease (QoL-AD). METHODS: A total of 120 patient-proxy pairs were recruited in six French hospitals and one French-speaking Swiss hospital to take part in the study. The patients presented mild to moderate AD (MMSE > or = 10). The QoL-AD was administered by an interviewer for patients and was self-administered for caregiver proxies. Thus, the psychometric validation enabled the study of feasibility, acceptability, reliability and convergent and discriminant validity of the instrument. RESULTS: The French version of the QoL-AD showed good internal consistency (Cronbach's alpha coefficient > or = 0.70) and good reliability (Intra-class correlation > 0.80) at a 2-week interval, for patient and caregiver questionnaires. Convergent validity, as indicated by correlation between the QoL-AD (disease-specific instrument) and the dimensions of the Duke Health Profile (generic instrument), was also good for eight dimensions in the Duke profile (p < 0.05). Discriminant validity showed a significant difference for depression (p = 0.0025) and did not show significant difference for two groups of dementia (p = 0.11). CONCLUSION: There is now a validated French version of the QoL-AD available, following transcultural adaptation according to international recommendations, which possesses good psychometric qualities.

[Integrated care systems for elderly people]. / Réseaux de soins intégrés gériatriques.

The care of the frail elderly is characterised by fragmentation and discontinuity within and between sectors, resulting in frequent and inappropriate hospitalisations and premature nursing home placement. Integrated models of care in Europe, and North America have proven to be effective in improving health status, satisfaction and utilisation of resources in the frail elderly. The purpose of this article is to describe these programmes and the community geriatrics unit of Geneva, which provides health care to a frail elderly population in collaboration with other partners in the primary care sector. The main objective of the unit is to enable the frail elderly to stay at home using a multidisciplinary comprehensive geriatric approach and coordinated long-term follow-up.