Impact of an Assessment of Risk Factors for Falls and Personalized Care, on Mortality and Institutionalization, After Intervention of the Urgent Medical Assistance Service (SAMU) in the Elderly Person at Home

Risk Factors for Falls After Intervention of the Urgent Medical Assistance Service (SAMU) in the Elderly Person at Home

Sponsors

Lead sponsor: University Hospital, Toulouse

Source University Hospital, Toulouse
Brief Summary

In this project, the investigators are interested in a particular population, that of elderly subjects who used the UAS 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 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 an IDEG (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 an IDEG at home in the elderly who used the UAS for a fall (with on-site care or hospitalization inferior to 24h), on the delay institutionalization or death before institutionalization compared to standard care.

Overall Status Recruiting
Start Date September 1, 2019
Completion Date April 2023
Primary Completion Date April 2023
Phase N/A
Study Type Interventional
Primary Outcome
Measure Time Frame
The delay between the T0 and Time of occurrence 2 years
Secondary Outcome
Measure Time Frame
Number of reminders to the SAMU for fall 2 years
Number of non-programmed hospitalizations 2 years
Evolution of the dependence level evaluated by the ADL scale 2 years
Evolution of the quality-of-life score evaluated by SF-12 2 years
Number of deceased or institutionalized subjects 2 years
Enrollment 1200
Condition
Intervention

Intervention type: Other

Intervention name: standardized gerontological evaluation (EGS)

Description: Evaluation (EGS): initially, the patient benefits from a complete EGS and a complete fall balance realized by an IDEG (initial visit V0) in the 7 working days following the intervention of the SAMU for fall. This assessment is based on the EGS (Rubenstein LZ, 1984) and the assessment of risk factors for falls (HAS, INPES).

Arm group label: Intervention group

Intervention type: Other

Intervention name: Proposal for a personalized intervention plan (PIP)

Description: A PIP containing personalized recommendations to improve the patient's state of health, treatment and environment as well as risk factors for falls is proposed during the multi-professional consultation and discussed by telephone with the attending physician (pre-arranged telephone appointment). with the latter). The PIP validated by the attending physician is delivered and explained to the patient by the IDEG in the week following the CPR during the V1 visit to the patient's home.

Arm group label: Intervention group

Intervention type: Other

Intervention name: Follow-up

Description: Four follow-up visits at 6, 12, 18 and 24 months (V2, V3, V4, V5) are performed at the patient's home. During these visits, the IDEG reassesses the person from the gerontological point of view and from the point of view of risk factors for falls. A mail containing the elements of interest is sent to the attending physician after each visit. The patient is also contacted by telephone by the IDEG at 2, 4, 9, 15 and 21 months of follow-up to maintain a link, identify possible difficulties and encourage him / her to apply the PIP recommendations.

Arm group label: Intervention group

Intervention type: Other

Intervention name: Usual care

Description: The patients included in the "control" group will benefit from the usual care as well as documentation on general recommendations to be put in place to prevent falls and to age in good health [series of brochures published by INPES for the elderly. They are informed by telephone of their home group by the IDEG. The documents are sent by mail to the patient's home address.

Arm group label: Comparison group - usual care

Eligibility

Criteria:

Inclusion Criteria:

- Age ≥ 70 years

- 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

Exclusion Criteria:

- Total dependency (ADL at 0)

- Entry in EHPAD already scheduled within 3 months

Gender: All

Minimum age: 70 Years

Maximum age: N/A

Healthy volunteers: No

Overall Official
Last Name Role Affiliation
Fati Nourhashemi, MD Principal Investigator University Hospital, Toulouse
Overall Contact

Last name: Fati Nourhashemi, MD

Phone: 5 61 77 70 38

Phone ext: 33

Email: [email protected]

Location
facility status contact contact_backup University Hospital Toulouse Fati Nourhashemi, MD 5 61 77 70 38 [email protected]
Location Countries

France

Verification Date

October 2019

Responsible Party

Responsible party type: Sponsor

Keywords
Has Expanded Access No
Number Of Arms 2
Arm Group

Arm group label: Intervention group

Arm group type: Experimental

Description: a standardized gerontological evaluation (EGS) and a fall balance performed at home by an IDEG the proposal for a Proposal for a personalized intervention plan (PIP) to correct potentially reversible and modifiable factors a close follow-up by the IDEG for the implementation of the PIP throughout the follow-up period of 24 months (6 home visits and 5 telephone follow-ups).

Arm group label: Comparison group - usual care

Arm group type: Active Comparator

Description: Usual Care with the provision of documentation on simple recommendations for the prevention of falls and aging well.

Acronym RISING-DOM
Study Design Info

Allocation: Randomized

Intervention model: Parallel Assignment

Intervention model description: Interventional multicenter and open, randomized study in parallel groups comparing two arms

Primary purpose: Other

Masking: None (Open Label)

Source: ClinicalTrials.gov