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Contribution à l’analyse économique des technologies de compensation de la perte d’autonomie fonctionnelle liée au vieillissement

Abstract : Falls are the cause of significant mortality and morbidity in the elderly. Thus, the issue of their prevention is a priority in social and health systems throughout the world. This is not a recent issue as it has been a subject of research for more than thirty years. It is also justified by the fact that more than 50% of falls among the elderly are preventable. Assistive technologies (TA)for mobility occupies an important place in prevention strategies. They modify the physical environment to facilitate or restore occupational performance in personal care, work and leisure activities. But these feats can only be achieved if these technical aids are accepted and well used by the patient.For this, support from a third party (professional and/or family) is essential because of the learning difficulties at older ages. In the UPSAV-ECOCAT device of the Limoges University Hospital, the abandonment of these technologies was among the risk factors for serious falls at home (OR: 17.41; 95% CI = [2.59 ;117.02]; p = 0.003), in addition to living in an urban area (OR: 11.46; 95% CI = [1.48 ;88.98]; p = 0.020) and performing activities of daily living (OR: 34.04; 95% CI = [1.59 ;727.86]; p = 0.024). Indeed, the incidence of serious falls at 6 months was higher in the "user group" compared to the "dropout group": respectively 57% (95% CI: [46%; 68%]), versus 21% (95% CI: [12%; 33%]), with p = 0.001. Quality of life and well-being scores were also higher among users, respectively 0.15 (95% CI: [0.13; 0.17]) versus 0.11 (95% CI: [0.08; 0.14]) for "dropouts" with p = 0.009 for QALYs, and 0.32 (95% CI: [0.30; 0.34]) versus 0.25 (95% CI: [0.23; 0.27]) with p < 0.001 for well-being. The highest additional gain per QALY gained was 81,125.00 euros and the lowest 20,271.50 euros. Following the same extremes, we find 46,428.57 euros and 11,583.71 euros for the additional gain per welfare gained. Again, following the same extremes, the highest and lowest earnings per serious fall avoided were 9,285.71 and 2,316.74 euros respectively.The use of TAfor mobility in the UPSAV-ECOCAT projectwas therefore cost effective. New information and communication technologies (NICT) play an important role in the prevention of falls in old people's homes. As part of the FALLDIAG device, Link Care Service's EDAO video-vigilance cameras detected serious falls and warned paramedical professionals. Their sensitivity and specificity were 75, 86%[69.29%; 91.44%] and 75% [32.57%; 100.00%] respectively. On the other hand, while the exploits of these cameras seemed to be wellappreciated by the residents, this was not the case with the paramedical professionals. Health insurance should therefore take charge of the technologies that are much advocated on a daily basis by rehabilitation professionals to prevent falls and the NICT that have shown their effectiveness in EHPADs. In addition, it is important that elderly patients, beneficiaries of AT, be followed by multidisciplinary teams.
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Submitted on : Tuesday, October 5, 2021 - 4:58:27 PM
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Abdoul Razak Sawadogo. Contribution à l’analyse économique des technologies de compensation de la perte d’autonomie fonctionnelle liée au vieillissement. Economies et finances. Université de Limoges, 2021. Français. ⟨NNT : 2021LIMO0038⟩. ⟨tel-03366535⟩

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