Falling at home for people over 65: an unprecedented experience by Gérontopôle de Toulouse

Reducing the incidence of fatal and hospitalized falls by 20% by 2024 among people over 65 years of age. This is the target set by the Minister in charge of Self-Government on the basis of two million falls counted each year among those over the age of 65.

In Toulouse, the teams Samu 31 and Gérontopole decided to intervene upstream. The Rising-Dom research programme, which was launched in October 2019 with funding from the Department of Health, focuses on people who have fallen into the home, and for whom hospitalization was not necessary (or less than 24 hours to do so). medical examinations) but who should have called His Highness or the firefighters to come. “It’s very common. We receive approximately 3,000 calls a year for falls, via remote assistance, caregivers, neighbors or spouses. We have staff dedicated to these interventions on weekends when there are fewer private ambulances. Immediately, we check jobs. Vitality, absence of pain, fracture, wound, and if everything is validated, the regulating doctor gives the green light to the person to stay at home,” explains Professor Vincent Ponce, Head of Samu 31 at the University Hospital Center (CHU) in Toulouse.

Home improvement and medical check-ups

For the past two years, a team from Gérontopôle at Toulouse University Hospital has been calling on these “fallenists” to give them the opportunity to join the Rising-Dom research program dedicated to healthy aging. Half of the 960 volunteers recruited in the former Midi-Pyrenees region were presented with a plan of action. “Our hypothesis is that it is possible to reduce recurrences and mortality, improve quality of life and delay entry into dependency and thus entry into an institution by engaging an expert geriatric nurse at home,” confirms Professor Fati Nourhachmi, geriatrician at Toulouse University Hospital. , responsible for the ‘geriatric sector’ of the Haute-Garonne Tarn Ouest group of hospitals.

“My mother, who was bedridden after her fall, regained the independence of her daily life”

Genevieve, 85, from Toulouse, joined Rising-Dom after the nightly fall in June 2020. “I immediately said yes, I need help,” sums up her daughter Christelle. During her visit, the program nurse took a tour of the family’s home, from the layout of the bedroom to the contents of the refrigerator. Genevieve also called for audio, visual and cognitive assessments. Her daughter agrees, saying, “The mum was really respectful in her environment and in her habits. Then we set up different things: a remote assistance bracelet from the county council, LEDs on the floor that would turn on when passing by, protein boosting in menus, hydration monitoring, reading The daily newspaper “goes down” to find herself in the letterbox at the bottom of the ladder, crossword puzzles, and games to preserve her memory. A nurse’s visit every six months and her contact every two months made it possible to follow up on the care plan without being too intrusive. My mother, who was bedridden after Her downfall, independence in many aspects of her daily life.

“Avoiding repetition, improving quality of life and delaying entry to nursing homes”

Prof. Fati Nourhachmi, geriatrician at Toulouse University Hospital, Head of the Geriatrics Sector at Haute-Garonne Tarn Quest Group of Hospitals, 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 in order to get up. In general, when this fall happens outside the home, it is about strong, energetic and mobile people. But when falls do occur indoors, they often hit those who are frail or in the onset of dependency. This is a target population that we don’t see in the hospital.

What do you want to prove?

We want to see if it is possible to reduce mortality, prevent recurrence of falls, delay admission to an institution, and improve quality of life by implementing proposals for care, home, cognitive assessments, etc. Because, in terms of the hospital, we have noticed that when we receive people in a state of dependence, even if it is mild, they have already fallen at home, and they have gone back and forth to the emergency room, but then slipped through the networks of the health network: we have just checked the consequences of the fall but we We did not look for the real reason.

How are you going to do that?

We recruited 960 people over the age of 75 in West Occitanie (formerly Midi-Pyrenees region) to get two random groups by lottery: one who would benefit from a home intervention and the other whose future we would follow simply by calls. At the end of two years of observation, we will be able to see if there is a difference and whether our proposals have been put into practice. This study is the first, it’s more common to bring people to the hospital rather than going home.