Risk Factors for Falls After Intervention of the Urgent Medical Assistance Service (SAMU) in the Elderly Person at Home
- Conditions
- Elderly
- Interventions
- Other: standardized gerontological evaluation (EGS)Other: Usual careOther: Proposal for a personalized intervention plan (PIP)Other: Follow-up
- Registration Number
- NCT04132544
- Lead Sponsor
- University Hospital, Toulouse
- Brief Summary
In this project, the investigators are interested in a particular population, that of elderly subjects who used the SAMU after a fall and who are not hospitalized or are hospitalized less than 24 hours. The scientific literature concerning this population is poor . However, this is a particularly vulnerable population. The Direction of research, studies, evaluation and statistics (DREES) report notes that in 2005 in metropolitan France, 24% of people aged 65 to 75 said they had fallen in the last 12 months. Home falls among seniors may require emergency medical services (EMS).
- Detailed Description
The first cause of accidental death in people over 65, the fall often has a pejorative impact on the physical, psychological and quality of life . It is also predictive of entry into an institution.
In this project, the investigators propose to evaluate the patient at home with a Gerontological Assessment Nurse working in collaboration with the attending physician, whenever the fall triggers a call to the SAMU (without hospitalization or with hospitalization of less than 24 hours). In addition to the evaluation, the nurse will propose a personalized intervention plan (PIP) based on targeted and prioritized actions.
The Main objective is to study the effect of a personalized intervention plan (PIP) proposed by a Gerontological Assessment Nurse at home in the elderly who used the SAMU for a fall (with on-site care or hospitalization inferior to 24h), on the delay institutionalization or death before institutionalization compared to standard care.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 952
- Living at home
- Living at maximum 45 minutes from a hospital center participating in the study (for logistical reasons and practices of study organization)
- Intervention of the SAMU for a fall at home without there being hospitalization or with hospitalization lasting less than 24h
- Patient or trusted person capable of giving telephone information
- Patient or his / her trusted person who has agreed to participate in the study
- Patient affiliated to a social security scheme
- Total dependency (ADL at 0)
- Entry in nursing home already scheduled within 3 months
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Intervention group Proposal for a personalized intervention plan (PIP) * a standardized gerontological evaluation (EGS) and a fall balance performed at home by a Gerontological Assessment Nurse * the proposal for a Proposal for a personalized intervention plan (PIP) to correct potentially reversible and modifiable factors * a close follow-up by the Gerontological Assessment Nurse for the implementation of the PIP throughout the follow-up period of 24 months (6 home visits and 5 telephone follow-ups). Intervention group standardized gerontological evaluation (EGS) * a standardized gerontological evaluation (EGS) and a fall balance performed at home by a Gerontological Assessment Nurse * the proposal for a Proposal for a personalized intervention plan (PIP) to correct potentially reversible and modifiable factors * a close follow-up by the Gerontological Assessment Nurse for the implementation of the PIP throughout the follow-up period of 24 months (6 home visits and 5 telephone follow-ups). Intervention group Follow-up * a standardized gerontological evaluation (EGS) and a fall balance performed at home by a Gerontological Assessment Nurse * the proposal for a Proposal for a personalized intervention plan (PIP) to correct potentially reversible and modifiable factors * a close follow-up by the Gerontological Assessment Nurse for the implementation of the PIP throughout the follow-up period of 24 months (6 home visits and 5 telephone follow-ups). Comparison group - usual care Usual care Usual Care with the provision of documentation on simple recommendations for the prevention of falls and aging well.
- Primary Outcome Measures
Name Time Method The delay between the T0 and Time of occurrence 2 years The composite criterion corresponding to the delay between the T0 and the occurrence of an institutionalization or a death before institutionalization (first event occurring).
In this pilot study, the average age of subjects was 83.6 years. This is a population for which the goals of home care and delay in the onset of dependence and in the occurrence of death are interesting and feasible.
- Secondary Outcome Measures
Name Time Method Number of reminders to the SAMU for fall 2 years The average number of SAMU recalls for drop during the follow-up period will be compared between the two groups at 12 and 24 months after inclusion. This data is collected from a regional database of regulatory data in partnership with the Regional Health Agency (ARS) for all subjects included.
Number of non-programmed hospitalizations 2 years Hospitalizations will be collected for all patients included during the follow-up. We will compare more specifically the unplanned hospitalizations: the average number of unplanned hospitalizations will be compared between the two groups at 12 and 24 months of follow-up.
This data is collected during the unannounced semi-annual telephone call of the subjects' home groups.Number of deceased or institutionalized subjects 2 years The number of deceased or institutionalized subjects during the follow-up period will be compared between the two groups at 12 and at 24 months of follow-up. This data is collected in both groups during the unannounced semiannual telephone call of the groups belonging to the subjects.
Evolution of the dependence level evaluated by the ADL scale 2 years Katz's scale of functional independence for activities of daily living (Katz S, 1963), commonly known as Katz's ADL (Katz Activity of Living Living Scale), is the most appropriate tool for assessing functional abilities. basic patient. Clinicians generally use this tool to detect problems with performing 6 basic activities of daily living and to plan care accordingly. The score varies from 0 (completely dependent) to 6 (completely autonomous). A score of 4 indicates a moderate functional deficit and 2 a severe functional deficit.
Evolution of the quality-of-life score evaluated by Short Form -12 2 years The investigators will use the Short Form-12 Quality of Life Scale, which is an abbreviated version of the Medical Outcomes Study Short-Form General Health Survey, with only 12 of the 36 questions that can save a lot of time. It is a generic questionnaire that makes it possible to compare groups of subjects with different pathologies. It measures eight aspects of quality of life that reflect
World Health Organization (WHO) definition of quality of life: general and mental health, physical and social functioning, physical and emotional health, pain and vitality.
Compared to the Short Form-36, the Short Form-12 has the advantage of being shorter, less time-consuming, thus easier for the evaluator and better tolerated by patients. Its results are correlated with those of the Short Form-36.
The Short Form-12 allows to obtain two scores (between 0 and 100, calculated thanks to an algorithm):
* a score of quality of mental and social life
* and a physical quality of life score.
Trial Locations
- Locations (12)
CH Lannemezan
🇫🇷Lannemezan, France
University Hospital Toulouse
🇫🇷Toulouse, France
CH Lavaur
🇫🇷Lavaur, France
CH Montauban
🇫🇷Montauban, France
CH Rodez
🇫🇷Rodez, France
CH Castres-Mazamet
🇫🇷Castres, France
Maison de Santé Pluri-professionnelle
🇫🇷Vic-Fezensac, France
CH Albi
🇫🇷Albi, France
CH Cahors
🇫🇷Cahors, France
CHIVA
🇫🇷Foix, France
CH Ariège Couserans
🇫🇷Saint-Girons, France
CH Bigorre
🇫🇷Tarbes, France