Proposal of a service delivery integration index of home care for older persons: application in several European cities.

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldPURPOSE: To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. THEORY: Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. METHOD: Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in "Aged in Home care" (AdHoc) study to capture basic characteristics of home care services. Their summation leads to a services' delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. RESULTS: Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. CONCLUSION: The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity

Proposal of a service delivery integration index of home care for older persons : application in several European cities

Purpose: To propose an integration index of home care delivery to older persons, to study its validity and to apply it to home care services of European cities. Theory: Home care delivery integration was based on two dimensions referring to process-centred integration and organisational structure approach. Method: Items considered as part of both dimensions according to an expert consensus (face validity) were extracted from a standardised questionnaire used in ‘‘Aged in Home care’’ (AdHoc) study to capture basic characteristics of home care services. Their summation leads to a services’ delivery integration index. This index was applied to AdHoc services. A factor analysis was computed in order to empirically test the validity of the theoretical constructs. The plot of the settings was performed. Results: Application of the index ranks home care services in four groups according to their score. Factor analysis identifies a first factor which opposes working arrangement within service to organisational structure bringing together provisions for social care. A second factor corresponds to basic nursing care and therapies. Internal consistency for those three domains ranges from 0.78 to 0.93. When plotting the different settings different models of service delivery appear. Conclusion: The proposed index shows that behind a total score several models of care delivery are hidden. Comparison of service delivery integration should take into account this heterogeneity

Loss of independence in Katz's ADL ability in connection with an acute hospitalization: early clinical markers in French older people

Background: The preservation of autonomy and the ability of elderly to carry out the basic activities of daily living, beyond the therapeutic care of any pathologies, appears as one of the main objectives of care during hospitalization. Objectives: To identify early clinical markers associated with the loss of independence in elderly people in short stay hospitals. Methods: Among the 1,306 subjects making up the prospective and multicenter SAFEs cohort study (Sujet Agé Fragile: Évolution et suivi—Frail elderly subjects, evaluation and follow-up), 619 medical inpatients, not disabled at baseline and hospitalized through an emergency department were considered. Data used in a multinomial logistic regression were obtained through a comprehensive geriatric assessment (CGA) conducted in the first week of hospitalization. Dependency levels were assessed at baseline, at inclusion and at 30days using Katz's ADL index. Baseline was defined as the dependence level before occurrence of the event motivating hospitalization. To limit the influence of rehabilitation on the level of dependence, only stays shorter than 30days were considered. Results: About 514 patients were eligible, 15 died and 90 were still hospitalized at end point (n=619). Two-thirds of subjects were women, with a mean age of 83. At day 30 162 patients (31%) were not disabled; 61 (12%) were moderately disabled and 291 severely disabled (57%). No socio-demographic variables seemed to influence the day 30 dependence level. Lack of autonomy (odds ratio (OR)=1.9, 95% confidence interval (CI)=1.2-3.6), walking difficulties (OR=2.7, 95% CI=1.3-5.6), fall risk (OR=2.1, 95% CI=1.3-6.8) and malnutrition risk (OR=2.2, 95% CI=1.5-7.6) were found in multifactorial analysis to be clinical markers for loss of independence. Conclusions: Beyond considerations on the designing of preventive policies targeting the populations at risk that have been identified here, the identification of functional factors (lack of autonomy, walking difficulties, risk of falling) suggests above all that consideration needs to be given to the organization per se of the French geriatric hospital care system, and in particular to the relevance of maintaining sector-type segregation between wards for care of acute care and those involved in rehabilitatio

Incapacités et dépendance de la population âgée française : apport de l’enquête « Handicaps – Incapacités – Dépendance » (HID)

As a result of the HID survey, we now have a global view of the problem of dependence among the elderly in France. Based on the indicators retained (those of Katz, AGGIR and Colvez), between 700,000 and 2,045,000 out of the 12 million people aged 60 or older in France are dependent. The prevalence of institutionalization among people aged 60 or older is 4.1%. This proportion increases with age and is twice as great among women. According to the Colvez indicator, 25% of the elderly in institutions are confined to bed or a chair, 21.5% need help with washing and dressing, and 29.1% need a caregiver’s assistance to leave the institution. Less than 1% of persons aged 60 or older living at home are confined to bed, 2.6% require assistance with washing and dressing and 5.6% need help with leaving the house. In total, it is estimated that there are 630,000 highly dependent elderly persons, 34.5% of whom live in an institution. Lastly, the methodological approach used in developing the survey, which is amply reflected in the article, opens up numerous research avenues on one of the key concerns of political decision makers. AbstractGrâce à l’enquête «Handicaps, Incapacités, Dépendance» (HID), on dispose désormais d’une vision globale sur la question de la dépendance des personnes âgées en France. Selon les indicateurs retenus (ceux de Katz, d’AGGIR ou de Colvez), on dénombre entre 700 000 et 2045000 personnes dépendantes parmi les 12 millions de personnes de 60 ans et plus que compte l’Hexagone. La prévalence d’institutionnalisation parmi les personnes de 60 ans et plus est de 4,1%. Cette proportion augmente avec l’âge et est deux fois plus élevée chez les femmes. Selon l’indicateur de Colvez, 25% des personnes âgées en institution sont confinées au lit ou au fauteuil, 21,5% ont besoin d’aide pour la toilette et pour l’habillage et 29,1% nécessitent le concours d’un aidant pour sortir de l’établissement. Parmi les 60 ans et plus vivant à domicile, moins de 1% est confiné au lit. Quant à celles qui nécessitent une aide pour la toilette et l’habillage ainsi que pour sortir de chez eux, elles représentent respectivement 2,6 et 5,6 %. Au total, on évalue à 630 000 le nombre de personnes âgées dépendantes lourdes, dont 34,5% résident en institution. Enfin, l’importante réflexion méthodologique menée lors de la mise au point de l’enquête, et dont l’article fait largement écho, ouvre de nombreuses pistes de recherche sur un sujet au centre des préoccupations des décideurs politiques.Ankri Joël, Mormiche Pierre. Incapacités et dépendance de la population âgée française : apport de l’enquête « Handicaps – Incapacités – Dépendance » (HID). In: Santé, Société et Solidarité, n°2, 2002. Vieillissement et santé. pp. 25-38

Médicaments et personnes âgées : facteurs de modulation des comportements

REIMS-BU Santé (514542104) / SudocPARIS-BIUP (751062107) / SudocSudocFranceF

Evolution des profils d'état de santé et utilisation des services sociosanitaires chez les personnes âgées

LE KREMLIN-B.- PARIS 11-BU Méd (940432101) / SudocSudocFranceF

Environmental barriers matter from the early stages of functional decline among older adults in France

Background The adaptation of living environments can preserve functional independence among older people. A few studies have suggested that this would only benefit the most impaired. But conceptual models theorize that environmental pressure gradually increases with functional decline. Objectives We examined (1) how far different environmental barriers increased difficulties and favoured resort to assistance; (2) at what stage in functional decline environmental barriers begin to matter. Methods We used the French cross-sectional survey CARE (2015), including 7,451 participants (60+) with at least one severe functional limitation (FL). Multinomial logistic regressions models were used to compare predicted probabilities for outdoor activities of daily living (OADL) difficulties (no OADL difficulties; difficulties but without assistance; use of assistance) among individuals with and without environmental barriers (self-reported or objective), in relation to the number of FLs. Results Poor-quality pedestrian areas and lack of places to rest were associated with a higher probability of experiencing OADL difficulties, whatever the number of FLs; the association increased with the number of FLs. Up to 6 FLs, individuals with these barriers were more likely to report difficulties without resorting to assistance, with a decreasing association. Living in cities/towns with high diversity of food outlets was associated with a lower probability of reporting assistance, whatever the number of FLs, but with a decreasing association. Discussion Overall, the results suggest that environmental barriers increasingly contribute to OADL difficulties with the number of FLs. Conclusions differed as to whether they tended to favour resort to assistance, but there was a clear association with food outlets, which decreased with impairment severity. The adaptation of living environments could reduce difficulties in performing activities from the early stages of decline to the most severe impairment. However, the most deteriorated functional impairments seem to generate resort to assistance whatever the quality of the environment

Economic Analysis of the Intangible Impacts of Informal Care for People with Alzheimer’s Disease and Other Mental Disorders

International audienceObjectives: Valuation of the intangible impacts of informal care remains a great challenge for economic evaluation, especially in the framework of care recipients with cognitive impairment. Our main objective was to explore the influence of intangible impacts of caring on both informal caregivers’ ability to estimate their willingness to pay (WTP) to be replaced and their WTP value. Methods: We mapped characteristics that influence ability or inability to estimate WTP by using a multiple correspondence analysis. We ran a bivariate probit model with sample selection to further analyze the caregivers’ WTP value conditional on their ability to estimate their WTP. Results: A distinction exists between the opportunity costs of the caring dimension and those of the intangible costs and benefits of caring. Informal caregivers’ ability to estimate WTP is negatively influenced by both intangible benefits from caring (P o 0.001) and negative intangible impacts of caring (P o 0.05). Caregivers’ WTP value is negatively associated with positive intangible impacts of informal care (P o 0.01). Conclusions: Informal caregivers’ WTP and their ability to estimate WTP are both influenced by intangible burden and benefit of caring. These results call into question the relevance of a hypothetical generalized financial compensation system as the optimal way to motivate caregivers to continue providing care. Keywords: Alzheimer, cognitive impairment, contingent valuation, informal care, intangible impact of caring. Copyright & 2013, International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc

[Life-course approach to cognitive ageing.]

International audienceThree recent developments hint at a paradigm shift in thinking about dementia: first, the importance of vascular risk factors has increased as these have been shown to be associated with all dementias; second, it is increasingly recognized that there is an heterogeneity in cognitive ageing, and third there is an emerging > view of dementia that suggests that risk factors all along life time matter for cognitive outcomes. In this paper we discuss the application of this shift in thinking in relation to the results from the Whitehall II study; the specificity of this cohort is that it examines cognitive ageing trajectories starting in midlife. We discuss results relating to age, socioeconomic factors and vascular risk factors