Apports de la télémédecine et de l''intelligence artificielle en gérontologie : modélisation du besoin, stratégies de validation et de déploiement à l'échelle d'un territoire rural à faible densité médicale

The population is ageing and it is necessary to adapt our healthcare system to ensure the continuity of care pathway for nursing home residents located in rural and medical desert areas. New technologies could challenge the demographic transition but they need to be validated. We have implemented a methodology for validation, applicable to all innovative technologies (connected devices and Artificial Intelligence). Modelling the need is essential to ensure that the technology provides a targeted response. The 4-stage validation by the clinical research pipeline: feasibility / proof of concept / effectiveness and cost-effectiveness / deployment ensures scientific validation. Our work has demonstrated the feasibility of the gerontopreventive teleconsultations with a significant impact on the prevention of unplanned hospitalizations with an incremental cost-effectiveness ratio of 3 494 euros per avoided hospitalization. We also demonstrated significant efficiency in the prevention of a geriatric syndrome such as falls. Finally, at the organizational level, the setting up of a multi-professional working group has made it possible to co-construct documents and procedures that will be transposable to all future users. Our work shows that gerontopreventive activity is efficient and answers the care needs of the patient, the nursing home and the healthcare system.La population vieillit et il est nécessaire d’adapter notre système de soins pour s’assurer de la continuité du parcours de soins des résidents d’EHPAD situés en zone rurale et à faible densité médicale. Les nouvelles technologies pourraient répondre aux défis imposés par la transition démographie mais elles nécessitent une validation pour s’assurer de leur efficience. Nous avons choisi de mettre en place une méthodologie de validation applicable à l’ensemble des technologies innovantes (objets connectés et Intelligence artificielle). La modélisation du besoin est essentielle pour s’assurer que la technologie apporte une réponse ciblée. La validation en 4 étapes par le pipeline de recherche clinique : faisabilité / preuve de concept / efficacité et coût-efficacité / déploiement, assure une fiabilité scientifique. Nos travaux ont permis de démontrer la faisabilité de la téléconsultation gérontopréventive avec un impact significatif dans la prévention des hospitalisations non programmées avec un rapport incrémental coût-efficacité de 3 494 euros par hospitalisation évitée. Nous avons également démontré une efficience significative sur la prévention d’un syndrome gériatrique tel que la chute. Enfin, sur le plan organisationnel, la mise en place du groupe de travail pluriprofessionnel permet de co-construire des documents et des procédures qui seront transposables à l’ensemble des futurs utilisateurs. Nos travaux démontrent que l’activité gérontopréventive est efficiente et répond aux besoins en soins du patient, des EHPAD et du système hospitalier

Apports de la télémédecine et de l''intelligence artificielle en gérontologie : modélisation du besoin, stratégies de validation et de déploiement à l'échelle d'un territoire rural à faible densité médicale

The population is ageing and it is necessary to adapt our healthcare system to ensure the continuity of care pathway for nursing home residents located in rural and medical desert areas. New technologies could challenge the demographic transition but they need to be validated. We have implemented a methodology for validation, applicable to all innovative technologies (connected devices and Artificial Intelligence). Modelling the need is essential to ensure that the technology provides a targeted response. The 4-stage validation by the clinical research pipeline: feasibility / proof of concept / effectiveness and cost-effectiveness / deployment ensures scientific validation. Our work has demonstrated the feasibility of the gerontopreventive teleconsultations with a significant impact on the prevention of unplanned hospitalizations with an incremental cost-effectiveness ratio of 3 494 euros per avoided hospitalization. We also demonstrated significant efficiency in the prevention of a geriatric syndrome such as falls. Finally, at the organizational level, the setting up of a multi-professional working group has made it possible to co-construct documents and procedures that will be transposable to all future users. Our work shows that gerontopreventive activity is efficient and answers the care needs of the patient, the nursing home and the healthcare system.La population vieillit et il est nécessaire d’adapter notre système de soins pour s’assurer de la continuité du parcours de soins des résidents d’EHPAD situés en zone rurale et à faible densité médicale. Les nouvelles technologies pourraient répondre aux défis imposés par la transition démographie mais elles nécessitent une validation pour s’assurer de leur efficience. Nous avons choisi de mettre en place une méthodologie de validation applicable à l’ensemble des technologies innovantes (objets connectés et Intelligence artificielle). La modélisation du besoin est essentielle pour s’assurer que la technologie apporte une réponse ciblée. La validation en 4 étapes par le pipeline de recherche clinique : faisabilité / preuve de concept / efficacité et coût-efficacité / déploiement, assure une fiabilité scientifique. Nos travaux ont permis de démontrer la faisabilité de la téléconsultation gérontopréventive avec un impact significatif dans la prévention des hospitalisations non programmées avec un rapport incrémental coût-efficacité de 3 494 euros par hospitalisation évitée. Nous avons également démontré une efficience significative sur la prévention d’un syndrome gériatrique tel que la chute. Enfin, sur le plan organisationnel, la mise en place du groupe de travail pluriprofessionnel permet de co-construire des documents et des procédures qui seront transposables à l’ensemble des futurs utilisateurs. Nos travaux démontrent que l’activité gérontopréventive est efficiente et répond aux besoins en soins du patient, des EHPAD et du système hospitalier

Contributions of telemedicine and Artificial Intelligence in gerontology : need‘s modelling, validation and deployment strategies in a rural territory with low medical density

La population vieillit et il est nécessaire d’adapter notre système de soins pour s’assurer de la continuité du parcours de soins des résidents d’EHPAD situés en zone rurale et à faible densité médicale. Les nouvelles technologies pourraient répondre aux défis imposés par la transition démographie mais elles nécessitent une validation pour s’assurer de leur efficience. Nous avons choisi de mettre en place une méthodologie de validation applicable à l’ensemble des technologies innovantes (objets connectés et Intelligence artificielle). La modélisation du besoin est essentielle pour s’assurer que la technologie apporte une réponse ciblée. La validation en 4 étapes par le pipeline de recherche clinique : faisabilité / preuve de concept / efficacité et coût-efficacité / déploiement, assure une fiabilité scientifique. Nos travaux ont permis de démontrer la faisabilité de la téléconsultation gérontopréventive avec un impact significatif dans la prévention des hospitalisations non programmées avec un rapport incrémental coût-efficacité de 3 494 euros par hospitalisation évitée. Nous avons également démontré une efficience significative sur la prévention d’un syndrome gériatrique tel que la chute. Enfin, sur le plan organisationnel, la mise en place du groupe de travail pluriprofessionnel permet de co-construire des documents et des procédures qui seront transposables à l’ensemble des futurs utilisateurs. Nos travaux démontrent que l’activité gérontopréventive est efficiente et répond aux besoins en soins du patient, des EHPAD et du système hospitalier.The population is ageing and it is necessary to adapt our healthcare system to ensure the continuity of care pathway for nursing home residents located in rural and medical desert areas. New technologies could challenge the demographic transition but they need to be validated. We have implemented a methodology for validation, applicable to all innovative technologies (connected devices and Artificial Intelligence). Modelling the need is essential to ensure that the technology provides a targeted response. The 4-stage validation by the clinical research pipeline: feasibility / proof of concept / effectiveness and cost-effectiveness / deployment ensures scientific validation. Our work has demonstrated the feasibility of the gerontopreventive teleconsultations with a significant impact on the prevention of unplanned hospitalizations with an incremental cost-effectiveness ratio of 3 494 euros per avoided hospitalization. We also demonstrated significant efficiency in the prevention of a geriatric syndrome such as falls. Finally, at the organizational level, the setting up of a multi-professional working group has made it possible to co-construct documents and procedures that will be transposable to all future users. Our work shows that gerontopreventive activity is efficient and answers the care needs of the patient, the nursing home and the healthcare system

Les essais cliniques en homéopathie (aspects réglementaires et exemples d'études)

LILLE2-BU Santé-Recherche (593502101) / SudocSudocFranceF

Effectiveness of a Geriatric Emergency Medicine Unit for the Management of Neurocognitive Disorders in Older Patients: Results of the MUPACog Study

International audienceIntroduction: The prevalence of neurocognitive disorders (NCDs) increases with age and is associated with cognitive impairment. Older patients with NCD admitted to the emergency department (ED) are readmitted after discharge to home more often than those without NCD. Comprehensive geriatric assessment (CGA) is effective for improving clinical outcomes in older patients; however, the usefulness of CGA for older patients with NCD admitted to the ED has not been investigated. The main objective of our study is to assess the effectiveness of a geriatric emergency medicine unit (GEMU) for elderly patients with NCD admitted to the ED. Methods: This historical cohort study included patients aged 75 years and older with NCD admitted to the ED of Limoges University Hospital in France over a 4-year period. We compared patients treated in our hospital's GEMU, the MUPA unit (exposed group), and patients who received standard care by emergency physicians (control group). The primary end point was the incidence of 30-day readmissions. Results: The study included 801 patients admitted to the ED between January 1, 2015, and December 31, 2018 (400 in the exposed group). Of those, 72.5% were female, and the mean age was 87 ± 5 years. After adjusting for confounding factors, the 30-day readmission rate was significantly associated with the MUPA unit intervention. Conclusion: CGA in a GEMU improved health outcomes in elderly patients with NCD in the ED. We recommend that all EDs include a geriatric team, such as the MUPA unit, to treat all patients with NCD admitted to the ED

Efficacité d'une unité de Médecine d'Urgence de la personne âgée dans la prise en charge des personnes âgées atteintes de troubles neurocognitifs

International audienc

Effect of Clinical Pharmacy Services in an Older Adult Emergency Medicine Unit on Unplanned Rehospitalization of Older Adults Admitted for Falls: MUPA-PHARM Study

International audienc

Prevalence of mild hyponatremia and its association with falls in older adults admitted to an emergency geriatric medicine unit (the MUPA unit)

International audienceAbstract Background Hyponatremia is the most common electrolyte disorder in older adults and it can increase morbidity and mortality. Approximately one in three older adults fall each year; mild chronic hyponatremia can predispose this group to injurious falls and fractures and serum levels of sodium can also influence bone health. Little is known regarding the association between mild chronic hyponatremia and injurious fall prevalence in elderly patients admitted to the Emergency Department (ED). Therefore, the present study investigated the link between mild hyponatremia and the risk of injurious falls in elderly patients admitted to the Emergency Geriatric Medicine Unit (The MUPA Unit). Methods This cross-sectional study was conducted over 4 months and included patients ≥75 years of age who were admitted to the MUPA Unit of University Hospital Center of Limoges (France). Sociodemographic factors, fall events, comorbidities, medications, and sodium levels were assessed (hyponatremia was considered as sodium level < 136 mEq/L). Additionally, the short Comprehensive Geriatric Assessment (short-CGA), the Frailty score on the Short Emergency Geriatric Assessment (SEGA), and the Katz Activity of Daily Living (ADL) scale were administered. Results Of the 696 cases included in the final analysis, the mean age was 86.1 ± 5.6 years and 63.1% were female. The prevalence of falls was 27.9% (95% confidence interval [CI]: 24.6–31.2%) and that of mild hyponatremia was 15.9% (95% CI: 13.2–18.6%). The prevalence rate of mild hyponatremia was 13.2% (95% CI: 10.1–16.3%) in patients without falls and 26.1% (95% CI: 19.8–32.4%) in patients admitted for falls. Mild hyponatremia was significantly associated with falls (P < 0.001) and the adjusted odds ratio (OR) was 3.02 (95% CI: 1.84–4.96). Conclusions Because mild hyponatremia might be a risk factor for injurious falls and ED admission, determination of sodium levels during basic biomarker assessment on ED admission could be an important component of fall prevention strategies for the elderly

Underdiagnosis of dementia in the elderly suffering from cancer: data from a preliminary study in an oncogeriatric unit.

International audienc

Economic assessments of intervention strategies in the prevention of frailty for elderly of 60 years and over living at home: a systematic review

International audienceAbstract Introduction: The objective was to conduct a systematic review of economic assessment of interventional strategies, in the prevention of frailty in elderly of 60 years and over living at home. Methods: The keywords were searched in databases such as Pubmed, ScienceDirect, Google Scholar and Embase. Articles published in English and French between 31/10/2010 and 31/12/2021 were included. The CHEERS statement reading grid was used to assess the quality of the studies in terms of economic assessments. Results: The search had identified nine relevant research studies, including seven randomised controlled trials and two quasi-experimental studies. Of these studies, we classified them into three programs: five studies on frailty screening, three studies on falls prevention and one study on the analysis of drugs and treatments prescribed and delivered. According to the cost-effectiveness plan of these programs, four studies had no conclusion on economic results, two studies had a dominant strategy, less expensive and more efficient, and three studies had a dominated strategy, more expensive and not efficient. Only 40% of the studies were of good quality. Conclusion: Only two multidimensional and interdisciplinary intervention strategies were highly efficient, cost-effective and improved the quality of life of elderly. Economic results were more mixed. Many methodological weaknesses were present in these studies