As part of the dependency reform, one of the three reports proposes to develop identification consultations and assessments for fragile and pre-fragile people.
Attempt to prevent dependency and thus allow fragile people to preserve their autonomy. This is the heavy task to which Prime Minister Jean-Marc Ayrault will have to tackle, who made public on March 11 three reports with a view to the future reform of dependency. Preparatory to the law on the elderly, these reports are the work of the geriatrician Jean-Pierre Aquino, the general councilor of Val-d’Oise Luc Broussy and the deputy Martine Pinville (PS, Charente). These proposals aim to promote the adaptation of society to aging.
Among the measures envisaged by the Aquino report on the anticipation of dependence, one of them recommends the establishment of a real prevention consultation for people over 65 years of age.
Based on the already existing systems, the Aquino report recommends determining the means to better identify and integrate the most vulnerable elderly populations into this system. But also to fix the content which should be that of these consultations, in particular by referring to the recommendations of the High Authority of Health.
Finally, the document wants us to define the conditions under which these preventive consultations could be better organized, relying above all on the attending physician. Concretely, it is proposed to draw up specifications which will set common objectives for the various consultation regimes that already exist.
Prevention of falls
But to achieve this, the report stresses that a link needs to be structured between the various centers responsible for setting up periodic health examinations (CETAF, RSi, and MSA). And, the document proposes to go even further by organizing a working group bringing together all those involved in prevention assessments.
These next assessments should be designed in a global approach including the medical, psychological and social aspects of the beneficiaries. A concrete example, the prevention of falls. According to the report, in addition to the medical aspects, she will also be able to go through a podiatry assessment with prescription of care and wearing of plantar orthotics if necessary, while being concerned with the development of the living environment.
A thorough geriatric assessment
Identifying people in a situation of dependency is one of the essential elements presented in this working group. While France will soon know the figure of 1.5 million dependent people, the report calls for a specific organization to be set up to identify and treat people over the age of 65, fragile and pre-fragile.
The latter should benefit from an in-depth geriatric evaluation carried out by several professionals (doctor, dietitian, psychologist, etc.). And the assessment made by these health professionals should then in principle lead to the implementation of a personalized prevention plan. In practice, it is the attending physician who will have to ensure that the patient follows the recommendations proposed by the prevention plan.
Another proposal put forward is to further enhance the role of home helpers, for example by supplementing the training of these professionals with training adapted to pre-screening.
The example of Gerontopole of Toulouse
The rapporteurs propose to extend the Toulouse experience of gerontopole to five day hospitals in five test regions and more broadly to geriatric day hospitals.
As a reminder, the Gerontopole of Toulouse aims to bring together research teams and clinicians around a single structure in order to boost research, prevention and promote the health of the elderly. Two years after its founding, it fulfilled the objectives given to it. It now constitutes an efficient structure for care, health promotion and clinical research. It has also developed a relevant screening tool: 97% of patients referred by general practitioners to the frailty day hospital are pre-fragile or fragile.
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