如何在社区管理体弱的老年人？法国一个拥有16638名居民的城市所实施的健康促进项目提案。

How to Manage Frail Older Adults in the Community? Proposal of a Health Promotion Program Experienced in a City of 16,638 Inhabitants in France.

作者信息

de Kerimel J, Tavassoli N, Lafont C, Soto M, Pedra M, Nourhashemi F, Lagourdette C, Bouchon L, Chaléon A, Sourdet S, Rolland Y, Cesari M, Vellas B

机构信息

Justine de Kerimel, E-mail address:

出版信息

J Frailty Aging. 2018;7(2):120-126. doi: 10.14283/jfa.2017.47.

DOI:10.14283/jfa.2017.47

PMID:29741197

Abstract

BACKGROUND

Health promotion programs could prevent and delay frailty and functional decline. However, in practice, the planning and establishment of such a program is a challenge for health care providers. We report an experimental model of screening and management for frail elderly conducted in Cugnaux, city of 16,638 inhabitants in France, by the Toulouse Gerontopole and the social care service of the Cugnaux City Hall.

METHODS

A frailty screening self-administered questionnaire (FiND questionnaire) was sent to community-dwelling residents of 70 years old and over of Cugnaux. The completed questionnaires were analyzed and the subjects were classed into three groups: robust, frail, mobility disability, based on their score. Frail subjects and those with mobility disability invited to undergo a frailty assessment in the premises of the town hall realized by a nurse in order to identify the causes of their frailty and propose them a personalized intervention plan (PIP).

RESULTS

The FiND questionnaire was sent to the residents of Cugnaux of 70 years old and over (n=2,003). After two mailings, 860 (42.9%) completed questionnaires were received. Mean age of the responders was 79.0 ± 6.2 years and 59.6% women (n= 511). According to the questionnaires analysis, 393 (45.7%) were robust, 212 (24.6%) frail, 240 (27.9%) had a mobility disability and 15 (1.7%) could not be classified due to missing data. 589 (68.5%) subjects accepted to be contacted by the Gerontopole nurse. The assessment by the nurse was proposed to frail subjects and those with mobility disability (n=313). Until 31 December 2016, 136 patients have been evaluated. The mean age was 80.1±5.4 and most patients were women (69.9%). The mean ADL score was 5.8±0.5 and the IADL showed a mean score of 6.9±1.7. According to Fried definition of frailty, 76 patients (55.9%) were pre-frail, and 35 (25.7%) frail. Concerning the frailty domains identified, 75 patients (55.1%) showed the alteration of physical performance, 70 (51.5%) thymic disorders and 46 (33.8%) sensory disorders. Preventive interventions proposed in the PIP were mostly physical interventions (86.8%, n=118) followed by cognitive (61.8%, n=84) and nutritional (39.7%, n=54) interventions.

DISCUSSION

This project shows the feasibility to implement a care model in the community. It permitted a large identification of frail elderly people in the city population, insuring their assessment and clinical follow up to maintain their capacities and referring them to social services.

摘要

背景

健康促进项目可以预防和延缓衰弱及功能衰退。然而，在实际操作中，此类项目的规划和设立对医疗服务提供者而言是一项挑战。我们报告了法国图卢兹老年医学中心和库尼奥市政府社会护理服务部门在拥有16,638名居民的库尼奥市开展的一项针对体弱老年人的筛查与管理实验模型。

方法

向库尼奥市70岁及以上的社区居民发放一份衰弱筛查自填问卷（FiND问卷）。对填写完整的问卷进行分析，并根据得分将受试者分为三组：健康、衰弱、行动不便。邀请衰弱受试者和行动不便者在市政厅场地接受护士进行的衰弱评估，以确定其衰弱原因并为他们制定个性化干预计划（PIP）。

结果

FiND问卷被发送给库尼奥市70岁及以上的居民（n = 2,003）。经过两次邮寄，共收到860份（42.9%）填写完整的问卷。应答者的平均年龄为79.0±6.2岁，女性占59.6%（n = 511）。根据问卷分析，393人（45.7%）健康，212人（24.6%）衰弱，240人（27.9%）行动不便，15人（1.7%）因数据缺失无法分类。589名（68.5%）受试者同意老年医学中心的护士与他们联系。护士对衰弱受试者和行动不便者（n = 313）进行了评估。截至2016年12月31日，已评估136例患者。平均年龄为80.1±5.4岁，大多数患者为女性（69.9%）。日常生活活动（ADL）平均得分为5.8±0.5分，工具性日常生活活动（IADL）平均得分为6.9±1.7分。根据弗里德对衰弱的定义，76例患者（55.9%）为衰弱前期，35例（25.7%）为衰弱。在已确定的衰弱领域中，75例患者（55.1%）表现出身体机能改变，70例（51.5%）存在胸腺功能障碍，46例（33.8%）存在感觉障碍。PIP中提出的预防性干预措施大多为身体干预（86.8%，n = 118），其次是认知干预（61.8%，n = 84）和营养干预（39.7%，n = 54）。