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Integrated care for older people in France in 2020: findings, challenges, and prospects
- Authors:
- BAJEUX Emma, CORVOL Aline, SOMME Dominique
- Journal article citation:
- International Journal of Integrated Care, 21(S2), 2021, p.16. Online only
- Publisher:
- International Foundation for Integrated Care
Background: We analyze here major changes over the last decade in the French healthcare system for older people, in terms of the integrated care concept. Policies: During this period, the major theme of public policies was “care coordination.” Despite some improvements, the multiplication of experimental programs and the multiplicity of stakeholders distanced the French healthcare system from an integrated care model. Professionals and organizations generally welcomed these numerous programs. However, most often, the programs were insufficiently implemented or articulated, notably at a clinical level, because of the persistence of a high level of fragmentation of governance, despite the creation of regional health agencies 10 years ago. The COVID-19 crisis has highlighted this fragmentation. Moreover, we still lack data on the impact of these programs on people’s health trajectories and personal experiences. Conclusion: The French healthcare system seems more fragmented in 2020 than in 2010, despite improvements in the culture of professional collaboration. The future health reform is an opportunity to capitalize upon this progress and to implement “integrated care.” This implies a strong and continuous national leadership in governance and change management. (Edited publisher abstract)
COVID 19 and dementia: experience from six European countries
- Authors:
- BURNS Alistair, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, early cite 18 January 2021,
- Publisher:
- Wiley
The effects of Covid‐19 have been well documented across the world with an appreciation that older people and in particular those with dementia have been disproportionately and negatively affected by the pandemic. This is both in terms of their health outcomes (mortality and morbidity), care decisions made by health systems and the longer‐term effects such as neurological damage. The International Dementia Alliance (IDEAL) is a group of dementia specialists from six European countries and this paper is a summary of our experience of the effects of COVID‐19 on our populations. Experience from England, France, Germany, the Netherlands, Spain and Switzerland highlight the differential response from health and social care systems and the measures taken to maximise support for older people and those with dementia. The common themes include recognition of the atypical presentation of COVID‐19 in older people (and those with dementia) the need to pay particular attention to the care of people with dementia in care homes; the recognition of the toll that isolation can bring on older people and the complexity of the response by health and social services to minimise the negative impact of the pandemic. Potential new ways of working identified during the pandemic could serve as a positive legacy from the crisis. (Edited publisher abstract)
Ambulatory actigraphy correlates with apathy in mild Alzheimer’s disease
- Authors:
- DAVID Renaud, et al
- Journal article citation:
- Dementia: the International Journal of Social Research and Practice, 9(4), November 2010, pp.509-516.
- Publisher:
- Sage
Research has revealed apathy as one of the most common behavioural symptoms in Alzheimer’s disease (AD). This study examined the relationship between apathy and locomotor activity in mild AD. Thirty AD subjects and fifteen healthy controls were recruited from the Nice Memory Center, France. Apathy was assessed with the Apathy Inventory (AI). Patients with a score greater than three on the AI caregiver version are considered in this report as having apathy. Locomotor activity was assessed using a wrist-worn actigraph for 75 minutes, during which a neuropsychological and behavioural examination were performed followed by 15 minutes of free activity. Findings revealed that AD patients shown lower motor activity than healthy subjects. AD patients with apathy had lower motor activity than AD patients without apathy. Apathy total score correlated negatively with mean motor activity. Most of the total score correlation was accounted for by correlations between the apathy dimensions lack of initiative and lack of interest, with mean motor activity. It is suggested that ambulatory actigraphy could be a simple technique to assess apathy objectively as part of routine assessment of Alzheimer’s disease patients.
The inter-relationship between formal and informal care: a study in France and Israel
- Authors:
- LITWIN Howard, ATTIAS-DONFUT Claudine
- Journal article citation:
- Ageing and Society, 29(1), January 2009, pp.71-91.
- Publisher:
- Cambridge University Press
This study examined whether formal care services delivered to frail older people's homes in France and Israel substitute for or complement informal support. The two countries have comparable family welfare systems but many historical, cultural and religious differences. Data for the respondents aged 75 or more years at the first wave of the Survey of Health, Ageing and Retirement in Europe (SHARE) were analysed. Regressions were examined of three patterns of care from outside the household: informal support only, formal support only and both formal and informal care, with the predictor variables including whether informal help was provided by a family member living in the household. The results revealed that about one-half of the respondents received no help at all (France 51%, Israel 55%), about one-tenth received care from a household member (France 8%, Israel 10%), and one-third were helped by informal carers from outside the household (France 34%, Israel 33%). More French respondents (35%) received formal care services at home than Israelis (27%). Most predictors of the care patterns were similar in the two countries. The analysis showed that complementarity is a common outcome of the co-existence of formal and informal care, and that mixed provision occurs more frequently in situations of greater need. It is also shown that spouse care-givers had less formal home-care supports than either co-resident children or other family care-givers. Even so, spouses, children and other family care-givers all had considerable support from formal home-delivered care.
Preferences for routines in older people: associations with cognitive and psychological vulnerability
- Authors:
- BERGUA Valerie, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 21(10), October 2006, pp.990-998.
- Publisher:
- Wiley
Although routine activities are important to normal functioning across all phases of life, their expression in older people may be associated with cognitive and psychological vulnerability. The relationship between these variables was explored in 235 elderly French participants from the PAQUID cohort study. Cross-sectional positive associations were found between preferences for routines, anxiety and depression levels, and cognitive complaints. General cognitive decline over a three-year time span was also associated with a greater desire for routines at the end of this period. The progressive routinization of behaviours and activities in older people is discussed as a marker of affective and cognitive vulnerability, and its understanding has potential for improving the early detection of adaptation difficulties and overall care in this population.
Barriers and facilitators in the uptake of integrated care pathways for older patients by healthcare professionals: a qualitative analysis of the French national “Health Pathway of Seniors for Preserved Autonomy” pilot program
- Authors:
- LORETTE Lorette, et al
- Journal article citation:
- International Journal of Integrated Care, 21(2), 2021, p.7. Online only
- Publisher:
- International Foundation for Integrated Care
Introduction: Integrated care is a particularly promising approach in geriatrics – a field in which the medical, psychological and social issues are often complex. The uptake of integrated care by healthcare professionals (HCPs) is essential but varies markedly. The objective of the present study of healthcare professionals was to identify barriers to and facilitators of commitment to integrated care for seniors. Methods: We performed a two-step, qualitative study, comprising (i) six qualitative, semi-directive series of interviews with HCPs (hospital practitioners, family physicians, nurses and pharmacists) who agreed or disagreed to take part in the French national “Health Pathway of Seniors for Preserved Autonomy” (PAERPA) pilot program; and (ii) an analysis of the pooled results, in order to identify common concerns among the healthcare professionals. Results: We identified four key “barrier” and “facilitator” topics shared by HCPs who had committed to the pilot program and those who had not: (i) awareness of and/or interest in geriatric medicine and team working, (ii) the presence of a care coordinator; (iii) the provision of information about the program and about the patient, and communication between HCPs, and (iv) personal benefits for the HCPs and the patients. Key conclusions: The four key topics identified in this large qualitative study of several healthcare professions should be considered during the design and dissemination of integrated care pathways for older patients. (Edited publisher abstract)
Housing and ageing in France and Germany: the intergenerational solution
- Authors:
- LABIT Anne, DUBOST Nathalie
- Journal article citation:
- Housing Care and Support, 19(2), 2016, pp.45-54.
- Publisher:
- Emerald
Purpose: In France and Germany, intergenerational housing is put forward as an option by public authorities. This kind of housing scheme seems like a good solution for seniors and young people, from both an economic and a social point of view. But beyond this common philosophy, there are differences in the way intergenerational housing is being implemented in the two countries. France mainly favours the student-senior home-sharing model whereas the intergenerational collaborative housing (co-housing) model based on solidarity between seniors and families is gaining ground in Germany. This paper explores the reasons for these differences and present results from field surveys conducted in both countries. Design/methodology/approach: The qualitative methodology of the field surveys consisted essentially of semi-structured interviews with the young people and seniors living in these types of housing, in order to understand how they experienced intergenerational solidarity. Findings: The authors’ surveys revealed that certain conditions are essential for this intergenerational solidarity to be fully effective, notably voluntary participation and commitment to the project, and possibly external support to ensure that it is designed and implemented in the best possible way. Originality/value: This paper provides useful recommendations for decision makers who wish to support this type of housing concept based on intergenerational solidarity. (Publisher abstract)
Does flexible goal adjustment predict life satisfaction in older adults? a six-year longitudinal study
- Authors:
- BAILLY Nathalie, et al
- Journal article citation:
- Aging and Mental Health, 18(5), 2014, pp.662-670.
- Publisher:
- Taylor and Francis
Objective: The aim of the present study was to investigate the relationship between flexible goal adjustment and life satisfaction (as an enduring component of subjective well-being) using six-year longitudinal data from a sample of older adults.Methods: The study included 704 participants aged 63–97 years assessed four times over a six-year period. Simultaneous and lagged models were specified and estimated using structural equation modeling.Results: Both simultaneous and lagged coefficients indicated that a high score on flexible goal adjustment significantly predicted subsequent levels of life satisfaction.Conclusion: In line with successful ageing theory, our findings support the view that the ability to adjust personal goals flexibly is a central resource when unattainable goals are encountered and it contributes to well-being in old age. (Edited publisher abstract)
Development and validation of an instrument to detect depression in nursing homes. Nursing homes short depression inventory
- Authors:
- PRADO-JEAN Annie, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 26(8), August 2011, pp.853-859.
- Publisher:
- Wiley
Symptoms of depression are often missed in older nursing home residents because they may be dismissed as an inevitable consequence of ageing. This paper describes the construction of an instrument (NH-SDI) to detect depression in older nursing home residents. Three hundred and twenty eight older people were selected at random from 17 nursing homes in France, and examined by a single investigator. The examination included a psychiatric assessment, an evaluation of cognitive function, an evaluation of depressive state using four different instruments, and assessment of any changes in behaviour in those suffering from dementia. A scale of 16 dichotomous items (NH-SDI) was created. The internal consistency was satisfactory, as was its reliability with a sensitivity of 85% and a specificity of 87% for a cut-off score above 5. The authors concluded that the NH-SDI appeared to be a useful instrument for the detection of depression in nursing homes and could easily be used by staff as part of routine procedures.
Social cognitive determinants of physical activity among retired older individuals: an application of the health action process approach
- Authors:
- CAUDROIT Johan, STEPHAN Yannick, LESCANFF Christine
- Journal article citation:
- British Journal of Health Psychology, 16(2), May 2011, pp.404-417.
- Publisher:
- Wiley
The health action process approach (HAPA) has proved to be a valid framework for the prediction of physical activity among both middle-aged and older adults in rehabilitation and work settings. The HAPA distinguishes between a pre-intentional motivational phase and a subsequent post-intentional volition phase in which the intention is translated into behaviour. It suggests that coping self-efficacy is a crucial construct in this second phase. There is currently little information on the predictive value of HAPA among older adults in their retirement years. This 6-month prospective study involved retired older individuals (n=120, age 53-83, mean 65.38 years) who were members of a university-based organisation in France. They were surveyed for risk perception, action self-efficacy, outcome expectancies, and physical intention at baseline and planning, coping self-efficacy, and physical activity 6 months later. Path analyses revealed that, in the motivational phase, action self-efficacy and risk perception, but not outcome expectancies, were positively related to activity intention. In the volitional phase, intention and coping self-efficacy, but not planning, were positive predictors of physical activity behaviour. The authors conclude that HAPA is a useful framework for the understanding of the social cognitive processes underlying this physical activity behaviour in older retired adults.