A fall does not necessarily lead to hospitalization, but it can be an alert. 30% of people over 75 fall at least once a year. A regional research program from the Gérontopôle de Toulouse offers a personalized care plan to prevent recurrences and improve the quality of life at home. In two years, 960 volunteers from the former Midi-Pyrénées region have been recruited.
Reduce fatal and hospitalized falls by 20% by 2024 among people over 65. This is the objective set by the minister responsible for autonomy on the basis of two million falls counted each year among the over 65s.
In Toulouse, the Samu 31 and Gérontopole teams decided to intervene upstream. The Rising-Dom research program, launched in October 2019 and funded by the Ministry of Health, focuses on people who have fallen at home, for whom hospitalization was not necessary (or less than 24 hours to do so). medical check-ups) but who had to call the Samu or the firefighters to get up. “It’s very common. We receive nearly 3,000 calls a year for falls, via remote assistance, carers, neighbors or spouses. We have a crew dedicated to these interventions on weekends when private ambulances are less numerous. On the spot, we check the vital functions, the absence of pain, fracture, wound and if everything is validated, the regulating doctor gives the green light for the person to stay at home”, explains Professor Vincent Bounes, head of the Samu 31 at the University Hospital Center (CHU) of Toulouse.
Home improvement, medical check-ups
For the past two years, a team from the Gérontopôle of the Toulouse University Hospital has been calling on these “fallers” to offer them the opportunity to join the Rising-Dom research program dedicated to healthy ageing. Half of the 960 volunteers recruited in the former Midi-Pyrénées region were offered an action plan. “Our hypothesis is that it is possible to reduce recurrences, mortality, improve quality of life and delay entry into dependency and therefore into an institution by involving a nurse expert in geriatrics at home”, emphasizes Professor Fati Nourhashemi, geriatrician at the Toulouse University Hospital, responsible for the “Aging sector” of the Haute-Garonne Tarn Ouest hospital group.
“Mom, who was bedridden after her fall, regained autonomy in her daily life”
Geneviève, an 85-year-old from Toulouse, joined the Rising-Dom program after a nocturnal fall in June 2020. “I immediately said yes, I needed help”, sums up her daughter Christelle. During her visit, the program nurse toured the family home, from the layout of the bedroom to the contents of the refrigerator. She also invited Geneviève to carry out auditory, visual and cognitive assessments. Her daughter approves: “Mom was really considered in her environment, in her habits. We then set up various things: remote assistance bracelet from the county council, LED lamps on the ground which are triggered when passing through, increase in the proportion of proteins in the menus, monitoring of hydration, reading of the daily newspaper ‘she goes down to look for herself in the letterbox located at the bottom of the stairs, crossword puzzles, games to maintain her memory. The nurse’s visit every six months and her calls every two months made it possible to follow the care plan without being too intrusive. Mom, who was bedridden after her fall, has regained autonomy in many things of her daily life.
Five signs to watch out for
The Ministry of Solidarity and Health invites to monitor five signs that increase the risk of falling in people over 65: physical inactivity, fear of falling, malnutrition, loss of sight and hearing , certain housing improvements.
“Avoiding recurrences, improving quality of life and delaying entry into nursing homes”
Professor Fati Nourhashemi, geriatrician at the Toulouse University Hospital, head of the “Aging sector” of the Haute-Garonne Tarn Ouest hospital group, directs the Rising-Dom research program on healthy aging
Why did you develop the Rising Dom research program?
We started from the observation that 30% of people over the age of 75 fall at least once a year with the need for intervention to get up. Generally, when this fall occurs outside the home, it concerns robust, active, mobile people. But when the fall occurs inside the home, it more often affects people who are fragile or at the start of dependency. This is a target population, which we do not see in the hospital.
What do you want to demonstrate?
We want to see if it is possible to reduce mortality, prevent recurrences of falls, delay entry into an institution, improve quality of life by implementing proposals for care, home, cognitive assessments, etc. Because, on the hospital side, we have noticed that when we receive people in a situation of dependency, even light, they have already fallen at home, have gone back and forth to the emergency room but then slipped through the meshes of the health net: we had just checked the consequences of the fall but we had not looked for the real cause.
How are you going to do it?
We recruited 960 people over the age of 75 in western Occitanie (formerly the Midi-Pyrénées region) to have two groups randomized by drawing lots: one group which benefits from a home intervention and another whose future we simply follow. by calls. At the end of the two years of monitoring, we will be able to see if there is a difference and if our proposals have been put in place. This study is a first, it is more common to bring people to the hospital than to go to their homes.