BACKGROUND:To describe the implementation of the ICOPE program in France using a digital tool in order to: (1) describe the characteristics of people completing the screener, identifying differences across assessors (healthcare professionals (HCPs), non-HCPs, or self-assessment); (2) describe the characteristics of follow-up and assessments for people with abnormal screening test; and (3) describe the recommendations in the intervention care plans for people with a decline in intrinsic capacity. METHODS:A descriptive study, presenting the results at initial screening, as well as at assessment when needed, and the recommendations issued during Step 3. We compared these results based on whether the participant was enrolled by an HCP, by a non-HCP, or by self-assessment. RESULTS:A total of 27 082 participants were enrolled. 67.9% were registered by HCPs. 90.8% participants screened positive at Step 1. Participants who completed the self-assessment were significantly younger (70.9 years vs 76.4 for HCPs or 77.9 for non-HCPs, p < .01) and less frequently had alerts in Step 1 (83.8% vs 90.8% for HCPs or 94.8% for non-HCPs). Step 2 in-depth assessments were carried out for 8.9% of the participants. In Step 2, only the SPPB showed significantly better motor abilities in individuals enrolled through self-assessment (median and IQR: 11 (10-12) vs 10 (8-12) for HCPs and 10 (7-12) for non-HCPs). Prevention care plans were proposed, mainly physical activity (n = 833, 33.7%) and nutrition counseling (n = 1 233, 51.7%). CONCLUSIONS:This study highlights the major role of HCPs in the implementation of the ICOPE program. Self-assessment enables the enrollment of more robust seniors, allowing for an early detection and treatment.

OBJECTIVES:To assess the prevalence of potentially avoidable transfers (PAT) and identify factors associated with these transfers to emergency departments (EDs) among nursing home (NH) residents. DESIGN:This is a secondary outcome analysis of the FINE study, a multicenter observational study collecting data on NH residents, NH settings, and contextual factors of ED transfers. SETTINGS AND PARTICIPANTS:NHs in the former Midi-Pyrénées region of the southwest of France (n = 312); a total of 1037 NH residents who experienced ED transfers (n = 1017) between January 2016 and December 2016. METHODS:The analysis included resident baseline characteristics and NH and transfer decision-making characteristics. An expert group categorized the transfer status as either PAT or unavoidable. Multivariable analysis using a mixed logistic model, accounting for intra-NH correlation, was conducted to assess factors independently associated with PAT. RESULTS:Among 1017 included transfers, 87.02% (n = 885) were identified as PAT and 12.98% (n = 132) unavoidable transfers. Multivariable analysis revealed that the following patient-related factors were associated with a likely high rate of PAT: usual behavior disturbances before transfer, including productive trouble (OR 2.04, 95% CI 1.25-3.33; P = .0044) and unusual symptom of falling during the week preceding the transfer (OR 4.55, 95% CI 1.76-11.82; P = .0019). On the other hand, distance between ED and NH (OR 0.98, 95% CI 0.97-0.998; P = .0231), NH staff trained in palliative care in the last 3 years (OR 0.52, 95% CI 0.29-0.95; P = .0324), the impossibility of direct hospitalization to an appropriate unit (OR 0.54, 95% CI 0.34-0.87; P = .0117), and the resident Charlson Comorbidity Index (OR 0.90, 95% CI 0.82-0.99; P = .0369) were associated with a lower probability of PAT. CONCLUSION AND IMPLICATIONS:Transfers from NHs to hospital EDs were frequently potentially avoidable, meaning that there are still significant opportunities to reduce PAT. Our findings may help to specifically identify interventions that should be targeted at both NH and resident levels.

Background The INSPIRE integrated care for older people (ICOPE)-CARE programme is a public health programme implementing the ICOPE health-care pathway in clinical practice. The primary objective of this study was to describe the large-scale implementation and feasibility of the INSPIRE ICOPE-CARE guidelines in clinical practice. The secondary aims were to describe the characteristics of patients who were identified as positive for abnormalities in intrinsic capacity (ie, locomotion, cognition, psychology, vitality, hearing, and vision) during step 1, and to describe the prevalence of these positive screenings. Methods In this prospective study, we evaluated a real-life population of users of primary care services in the Occitania region (France). Participants who were aged 60 years and older and lived in a community were eligible for inclusion in our study. Individuals aged >= 60 years were screened (step 1) by health-care providers or through self-assessments using digital tools (the ICOPE MONITOR app and the ICOPEBOT conversational robot). Our implementation strategy involved raising awareness among health-care professionals about the WHO ICOPE programme, training professionals in the ICOPE-CARE guidelines, and developing a digital infrastructure (ie, digital tools, a database, and a remote ICOPE monitoring platform). The feasibility of implementing the INSPIRE ICOPE-CARE guidelines was determined by the anticipated inclusion of >= 10 000 participants, and having a follow-up rate of over 50%. Findings Between Jan 1, 2020, and November 18, 2021, 10903 older people (mean age 76.0, SD 10.5 years; 6627 [60.8%] of whom were women) had a baseline step 1 screening done, and 5185 (70.4%) of 7367 eligible participants had a 6-month follow-up of step 1 screening. 10285 (94.3%) participants had a positive intrinsic capacity result during screening at baseline. 958 (9.3%) participants were evaluated with step 2 (in-depth assessments). Positive intrinsic capacity was confirmed in 865 (90. 3%) participants. Most recommendations in step 3 (care plan) were related to locomotion, vitality, and cognition. Interpretation The high number of participants included in our study, as well as the high rates of follow-up, provides evidence to suggest that the large-scale implementation of ICOPE in clinical practice is feasible. The very high prevalence of positive screening for impaired intrinsic capacity during step 1, as well as the high rates of confirmed deficits in intrinsic capacity during step 2, suggest that the INSPIRE ICOPE-CARE programme is able to target individuals who are at increased risk for functional loss and disability. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.

Background: The ICOPE (Integrated care for older people) approach is recommended by the WHO to foster healthy ageing and prevent care dependence in older people. However, its implementation in clinical practice has not yet been achieved and evaluated. The INSPIRE ICOPE CARE program aims to implement ICOPE in clinical practice in a large territory. The target population is non-care dependent adults aged 60 and over living at home.Methods: The program began with a first phase of awareness raising and training for healthcare professionals. In parallel, the ICOPE digital tools (ICOPE MONITOR, ICOPEBOT) and the ICOPE database have been developed to facilitate the screening, data collection and monitoring of participants’ state of health by healthcare professionals. A remote ICOPE monitoring platform was also created to support the healthcare professionals.Findings: Between January 1, 2020 and November 18, 10,903 older persons joined the program, age: 76.0 ± 10.5, 60.8% women. Among them, 9,363 (85.9%) carried out their first screening with a professional and 1,540 (14.1%) by self-assessment; 94.3% (n = 10,285) had potential abnormalities in at least one intrinsic capacity domain. A 6-month follow-up screening was performed for 70.4% of participants.Interpretation: The program allows early detection of declines in intrinsic capacity and sets up a new care pathway in prevention of care dependence. The adherence of 70.4% of the participants to the Step1 follow-up is an interesting result, which supports the feasibility of this model to reduce the loss of autonomy.Funding: This program was supported by Occitania Regional Health Agency, Region Occitanie/Pyrénées-Méditerranée (1901175), European Regional Development Fund (MP0022856) and APTITUDE project (EFA232/16).Declaration of Interest: None to declare.

The World Health Organization has developed the Integrated Care of Older People (ICOPE) strategy, a program based on the measurement of intrinsic capacity (IC) as "the composite of all physical and mental attributes on which an individual can draw". Multicomponent interventions appear to be the most effective approach to enhance IC and to prevent frailty and disability since adapted physical activity is the preventive intervention that has shown the most evidence in the treatment of frailty and risk of falls. Our paper describes the development of a multi-domain group-based intervention addressed to older people living in the community, aimed at improving and/or maintaining intrinsic capacity by means of promoting physical activity, healthy nutrition, and psychological wellbeing in older people. The process of intervention development is described following the Guidance for reporting intervention development studies in health research (GUIDED). The result of this study is the AMICOPE intervention (Aptitude Multi-domain group-based intervention to improve and/or maintain IC in Older PEople) built upon the ICOPE framework and described following the Template for Intervention Description and Replication (TIDieR) guidelines. The intervention consists of 12 face-to-face sessions held weekly for 2.5 h over three months and facilitated by a pair of health and social care professionals. This study represents the first stage of the UK Medical Research Council framework for developing and evaluating a complex intervention. The next step should be carrying out a feasibility study for the AMICOPE intervention and, at a later stage, assessing the effectiveness in a randomized controlled trial.

In France, in an unfavorable medico-economic context and facing medical recommendations for the prevention of weaknesses, Residential Care Homes for the Elderly or EHPAD (Établissements d’hébergement pour personnes âgées dépendantes) organize adapted physical activities. Based on a regional survey in Occitania over 255 establishments of the former Midi-Pyrénées region, this paper shows the diversity of projects in progress. The establishments favor a therapeutic approach involving various implementations and professional specializations. A typology of the programming modes of physical activity concludes that if some institutes favor a re-educational conception of physical activity, the majority prefers a recreational or socio-educational approach according to the means available locally.

Objectives: To determine the factors associated with the potentially inappropriate transfer of nursing home (NH) residents to emergency departments (EDs) and to compare hospitalization costs before and after transfer of individuals addressed inappropriately vs those addressed appropriately. Design: Multicenter, observational, case-control study. Setting and Participants: 17 hospitals in France, 1037 NH residents. Measures: All NH residents transferred to the 17 public hospitals' EDs in southern France were systematically included for 1 week per season. An expert panel composed of family physicians, emergency physicians, geriatricians, and pharmacists defined whether the transfer was potentially inappropriate or appropriate. Residents' and NHs' characteristics and contextual factors were entered into a mixed logistic regression to determine factors associated independently with potentially inappropriate transfers. Hospital costs were collected in the national health insurance claims database for the 6 months before and after the transfer. Results: A total of 1037 NH residents (mean age 87.2 +/- 7.1, 68% female) were transferred to the ED; 220 (21%) transfers were considered potentially inappropriate. After adjustment, anorexia [odds ratio (OR) 2.41, 95% confidence interval (CI) 1.57-3.71], high level of disability (OR 0.90, 95% CI 0.81-0.99), and inability to receive prompt medical advice (OR 1.67, 95% CI 1.20-2.32) were significantly associated with increased likelihood of potentially inappropriate transfers. The existence of an Alzheimer's disease special care unit in the NH (OR 0.66, 95% CI 0.48-0.92), NH staff trained on advance directives (OR 0.61, 95% CI 0.41-0.89), and calling the SAMU (mobile emergency medical unit) (OR 0.47, 95% CI 0.34-0.6 6) were significantly associated with a lower probability of potentially inappropriate transfer. Although the 6-month hospitalization costs prior to transfer were higher among potentially inappropriate transfers compared with appropriate transfers ( euro 6694 and euro 4894, respectively), transfer appropriateness was not significantly associated with hospital costs. Conclusions and Implications: Transfers from NHs to hospital EDs were frequently appropriate. Transfer appropriateness was conditioned by NH staff training, access to specialists' medical advice, and calling the SAMU before making transfer decisions. Trial Registration: clinicaltrials.gov, NCT02677272. (c) 2021 AMDA -The Society for Post-Acute and Long-Term Care Medicine.

Background: Each year, around one out of two nursing home (NH) residents are hospitalized in France, and about half to the emergency department (ED). These transfers are frequently inappropriate. This paper describes the protocol of the FINE study. The first aim of this study is to identify the factors associated with inappropriate transfers to ED.Methods/design: FINE is a case-control observational study. Sixteen hospitals participate. Inclusion period lasts 7 days per season in each center for a total period of inclusion of one year. All the NH residents admitted in ED during these periods are included. Data are collected in 4 times: before transfer in the NH, at the ED, in hospital wards in case of patient's hospitalization and at the patient's return to NH. The appropriateness of ED transfers (i. e. case versus control NH residents) is determined by a multidisciplinary team of experts.Results: Our primary objective is to determine the factors predisposing NH residents to inappropriate transfer to ED. Our secondary objectives are to assess the cost of the transfers to ED; study the evolution of NH residents' functional status and the psychotropic and inappropriate drugs prescription between before and after the transfer; calculate the prevalence of potentially avoidable transfers to ED; and identify the factors predisposing NH residents to potentially avoidable transfer to ED.Discussion: A better understanding of the determinant factors of inappropriate transfers to ED of NH residents may lead to proposals of recommendations of better practice in NH and would allow implementing quality improvement programs in the health organization.

The aim of the Impact d'une démarche QUAlité sur l’évolution des pratiques et le déclin fonctionnel des Résidents en Établissement d'hébergement pour personnes âgées dépendantes (IQUARE) study was to examine the effects of a global intervention comprising professional support and education for nursing home (NH) staff on quality indicators (QIs) and functional decline and emergency department (ED) transfers of residents. One hundred seventy‐five NHs in France (a total of 6,275 residents randomly selected from NHs) volunteered and were enrolled in a nonrandomized controlled multicenter individually customize trial with 18‐month follow‐up. NHs were allocated to a quality audit and feedback intervention (control group: 90 NHs, 3,258 residents) or to the quality audit and feedback intervention plus collaborative work meetings between a hospital geriatrician and NH staff (experimental group: 85 NHs, 3,017 residents). At the NH level, prevalence of assessment of kidney function, cognitive function, risk of pressure ulcers, behavioral disturbances, depression, pain, weight measurement, and transfer to the ED were recorded. Ability to perform basic activities of daily living was assessed at the resident level. At baseline, NH QIs were generally low (with large standard deviations), and annual rate of transfer to the ED was high (~20%) and similar in both groups. The intervention had a significant positive effect on the prevalence of assessment of pressure ulcer risk, depression, pain, and prevalence of ED transfers. It had no significant effect on functional decline. Large‐scale efforts to improve QIs involving collaboration between hospital and NH providers and based on audit and collaborative discussion are feasible and improve some aspects of quality of care in NHs.

Objectives: The burden of potential dementia cases without formal diagnosis on the health care system is almost unknown. This study examined the impact of potential dementia without formal diagnosis on the rate of visits to hospital emergency department (ED) of nursing home (NH) residents.Design: Cross-sectional study.Setting: NHs (175) located in France.Participants: A total of 5684 subjects who were living in the NH for at least 1 year.Measurements: Information on NHs' characteristics and on NH residents' health was recorded by NH staff. Participants were divided in 3 groups according to their dementia status: diagnosed dementia, potential dementia without formal diagnosis, and nondementia. The outcome measure was a binary variable: ED visits in the last 12 months (yes vs no). A mixed-effects logistic regression was performed on ED visits accounting for the random effects of living in a particular NH.Results: From the 5684 participants, 1036 had been seen in the ED. Adjusted odds ratio (AOR) showed that having a potential dementia without formal diagnosis, compared with a diagnosed dementia, was associated with an increased probability of ED visits (AOR = 1.25, 95% confidence interval: 0.99-1.59, P = .061); however, when a random NH effect was entered into the model, the association between potential dementia without formal diagnosis and ED visits disappeared (AOR = 1.22, 95% confidence interval: 0.95-1.57, P = .11).Conclusion: The association of potential dementia without formal diagnosis with ED visits varies across NHs. This intra-NH aspect (eg, organization and care habits) should be taken into account when examining the rates of hospitalization and possibly the use of health care services in general among NH residents. Copyright (C) 2013 - American Medical Directors Association, Inc.

Objectives: Very scarce information is available about the use of proton-pump inhibitors (PPI) in nursing homes (NH). This study investigated the factors associated with PPI use among NH residents.Design: Cross-sectionalSetting: One hundred seventy-five NHs in Midi-Pyrenees region, South-Western France.Participants: Data was collected for 6275 NH residents. Participants (73.7% women) were aged 86 years (+/- 8.2).Measurements: NH staff sent participants' drug prescriptions to research team; they also recorded information on residents' health characteristics. A binary logistic regression was performed on PPI use.Results: PPI use was highly prevalent (n = 2 370, ie, 37.8%). Whilst peptic ulcer (OR 4.741; 95% CI 3.647-6.163) and nonsteroidal anti-inflammatory drugs (OR 2.124; 95% CI 1.528-2.951) were important indicators of PPI use, they explained just a small fraction of PPI prescriptions; most prescriptions were probably inappropriately related to a general condition of health vulnerability, reflected by polypharmacy and comorbidities.Conclusions: Vulnerable people take PPIs more often in NHs. Physicians must be aware about the health risks possibly induced by inappropriate PPI use when prescribing these drugs for NH residents. Published by Elsevier Inc. on behalf of the American Medical Directors Association, Inc.

OBJECTIVES:Little information is available about associations between nursing home (NH) structural and organizational aspects and benzodiazepine prescriptions, particularly for long-acting drugs. This study addressed this knowledge gap. DESIGN:Cross-sectional study. SETTING:One hundred seventy-five NHs from France. PARTICIPANTS:A total of 6275 NH residents, aged 86 years (± 8.2), and mostly women (73.7%). MEASUREMENTS:Outcome measures were: (1) benzodiazepine and (2) long-acting benzodiazepine use. NH staff sent to research team all drug prescriptions in the week participants were included in the study; staff also recorded information on residents' characteristics, and NHs structure and internal organization. Binary logistic regressions were performed separately on total and long-acting benzodiazepine. RESULTS:A total of 3350 persons took benzodiazepine; 577 took long-acting benzodiazepine. Subject-related characteristics were the main correlates of benzodiazepine use. NH characteristics were also related to this outcome: number of beds ≥ 91 (Odds Ratio (OR) 0.820, 95% Confidence Interval (CI) 0.682-0.986), special care unit (OR 1.131, 95% CI 1.000-1.279), pharmacy for internal usage (OR 1.341, 95%CI 1.128-1.594), and date records of the first prescription of psychotropics (OR 1.394, 95% CI 1.209-1.607). Pharmacy for internal usage was also associated with long-acting benzodiazepine (OR 1.374, 95% CI 1.076-1.754). CONCLUSIONS:NH structure- and organization-related indicators impact benzodiazepine use among NH residents. This finding is of particular importance because these indicators are more easily modifiable than subject-related characteristics. Therefore, NH directors and medical staff should be aware about this to implement feasible modifications for reducing inappropriate and chronic benzodiazepine use.