与世界卫生组织（WHO）合作在奥克西塔尼地区实施 INSPIRE ICOPE-CARE 计划的框架。

Framework Implementation of the INSPIRE ICOPE-CARE Program in Collaboration with the World Health Organization (WHO) in the Occitania Region.

机构信息

Neda Tavassoli, Équipe Régionale Vieillissement et Prévention de la Dépendance (ERVPD), La Cité de la Santé, Bâtiment Ex-Biochimie, Hôpital La Grave, Place Lange, TSA 60033, 31059 Toulouse Cedex 9, France, Phone number: +335 61 77 70 13, Fax number: +335 61 77 64 75, E-mail address:

出版信息

J Frailty Aging. 2021;10(2):103-109. doi: 10.14283/jfa.2020.26.

DOI:10.14283/jfa.2020.26

PMID:33575698

Abstract

INTRODUCTION

Limiting the number of dependent older people in coming years will be a major economic and human challenge. In response, the World Health Organization (WHO) has developed the «Integrated Care for Older People (ICOPE)» approach. The aim of the ICOPE program is to enable as many people as possible to age in good health. To reach this objective, the WHO proposes to follow the trajectory of an individual's intrinsic capacity, which is the composite of all their physical and mental capacities and comprised of multiple domains including mobility, cognition, vitality / nutrition, psychological state, vision, hearing.

OBJECTIVE

The main objective of the INSPIRE ICOPE-CARE program is to implement, in clinical practice at a large scale, the WHO ICOPE program in the Occitania region, in France, to promote healthy aging and maintain the autonomy of seniors using digital medicine.

METHOD

The target population is independent seniors aged 60 years and over. To follow this population, the 6 domains of intrinsic capacity are systematically monitored with pre-established tools proposed by WHO especially STEP 1 which has been adapted in digital form to make remote and large-scale monitoring possible. Two tools were developed: the ICOPE MONITOR, an application, and the BOTFRAIL, a conversational robot. Both are connected to the Gerontopole frailty database. STEP 1 is performed every 4-6 months by professionals or seniors themselves. If a deterioration in one or more domains of intrinsic capacity is identified, an alert is generated by an algorithm which allows health professionals to quickly intervene. The operational implementation of the INSPIRE ICOPE-CARE program in Occitania is done by the network of Territorial Teams of Aging and Prevention of Dependency (ETVPD) which have more than 2,200 members composed of professionals in the medical, medico-social and social sectors. Targeted actions have started to deploy the use of STEP 1 by healthcare professionals (physicians, nurses, pharmacists,…) or different institutions like French National old age insurance fund (CNAV), complementary pension funds (CEDIP), Departmental Council of Haute Garonne, etc. Perspective: The INSPIRE ICOPE-CARE program draws significantly on numeric tools, e-health and digital medicine to facilitate communication and coordination between professionals and seniors. It seeks to screen and monitor 200,000 older people in Occitania region within 3 to 5 years and promote preventive actions. The French Presidential Plan Grand Age aims to largely implement the WHO ICOPE program in France following the experience of the INSPIRE ICOPE-CARE program in Occitania.

摘要

简介

在未来几年限制老年人口数量将是一项重大的经济和人力挑战。为此，世界卫生组织（WHO）制定了“老年人综合护理（ICOPE）”方法。ICOPE 计划的目标是使尽可能多的人健康老龄化。为了实现这一目标，世卫组织建议遵循个体内在能力的轨迹，这是其所有身体和精神能力的综合，包括多个领域，包括行动能力、认知能力、活力/营养、心理状态、视力、听力。

目的

INSPIRE ICOPE-CARE 计划的主要目标是在法国奥克西塔尼地区的临床实践中大规模实施世卫组织 ICOPE 计划，利用数字医学促进健康老龄化并维持老年人的自主性。

方法

目标人群是 60 岁及以上的独立老年人。为了跟踪这一人群，内在能力的 6 个领域都使用世卫组织提出的既定工具进行系统监测，特别是 STEP1，该工具已以数字形式进行调整，以实现远程和大规模监测。开发了两种工具：ICOPE MONITOR，一个应用程序，和 BOTFRAIL，一个对话机器人。两者都连接到 Gerontopole 虚弱数据库。STEP1 由专业人员或老年人自己每 4-6 个月进行一次。如果一个或多个内在能力领域出现恶化，算法会生成警报，从而使卫生专业人员能够快速干预。INSPIRE ICOPE-CARE 计划在奥克西塔尼的运营实施由老龄化和预防依赖（ETVPD）的地区团队网络负责，该网络拥有 2200 多名成员，由医疗、医疗社会和社会部门的专业人员组成。已开始采取有针对性的行动，部署医疗保健专业人员（医生、护士、药剂师等）或不同机构（如法国国家老年保险基金（CNAV）、补充养恤基金（CEDIP）、上加龙省地区理事会等）使用 STEP1。

展望

INSPIRE ICOPE-CARE 计划大量借鉴数字工具、电子卫生和数字医学，以促进专业人员和老年人之间的沟通和协调。它旨在 3 到 5 年内筛选和监测奥克西塔尼地区 20 万名老年人，并促进预防行动。法国总统大年龄计划旨在在奥克西塔尼的 INSPIRE ICOPE-CARE 计划的经验基础上，在法国广泛实施世卫组织 ICOPE 计划。