Project 2021-0QBA-297388 / FRQSC
Socio-Geriatric assessment (ESOGER): a telepractice clinical tool to fight against the deterioration of the health status and social isolation of vulnerable seniors.
Dr Olivier Beauchet, University of Montréal
Consequences of the pandemic due to the coronavirus (COVID-19) in the group of Quebec seniors (PA)
On March 13, 2020, Quebec was the first province in Canada to declare a state of health emergency due to the COVID-191 pandemic. seniors (i.e., ≥ 70 years of age), who represent 12.7% of the Quebec population – approximately 1 million people – were and are the age group most affected by this pandemic, both in terms of hospitalizations and deaths and in terms of altered health status and loss of independence. These complications are related to the coronavirus infection or consequences of measures taken to slow and prevent the progression of the disease in the general population.
One such measure is home confinement. At the general population level, home confinement has been and continues to be an effective intervention to control the progression of the pandemic. At the scale of the seniors group, it has unfortunate negative effects due to their previously impaired health status from chronic illnesses, making them more vulnerable to motor and psychological deconditioning. This deconditioning generated a vicious loop that accelerated the deterioration of their health – physical and mental – and their loss of autonomy (see Figure 1), exposing them to consequences such as isolation or even social exclusion, deterioration of their well-being and quality of life, the breakdown of intergenerational ties, the emergence of ageism and high financial costs related to significant recourse to health and social services (HSS) resources.
Figure 1. Alterations in the health of seniors: consequences and possible levers
Community stakeholders in home support services and care
The majority of Quebec’s seniors (92%) live at home. In Quebec, home support for seniors with impaired health and loss of autonomy is provided by three main categories of community actors (1) family caregivers (FCs) defined by the Ministry of Health and Social Services (MSSS) as “any person in the family or community who provides significant, ongoing or occasional support, in a non-professional capacity, to a person with a disability” and who represent 25% of the Quebec population; (2) the programme-services de Soutien à l’Autonomie des Personnes Âgées (SAPA) of the Centres Intégrés (Universitaires) de Santé et des Services Sociaux (CIUSSS and CISSS); and e., non-HSS network), including, among others (a) social economy enterprises in home assistance (EÉSAD) that provide so-called essential services, (b) the 211 service (telephone assistance service that fights against poverty and social exclusion, by allowing people to be quickly informed about nearby socio-community assistance resources), (c) L’Appui pour les proches aidants d’aînés (an organization that has been providing support services for seniors since 2009) or (d) “Les Petits Frères”, a non-profit organization that has been accompanying seniors at home since 1962 in Quebec or the Canadian Red-Cross.
Prior to the pandemic, 84% of seniors had an impaired health status due to at least one chronic condition and one in ten reported a disability that caused them to need assistance with daily activities. In 2016, an estimated 291,200 seniors out of 406,000 (or 72%) with multiple disabilities were receiving at least one home support service and/or care paid for in whole or in part by MSSS. This left approximately 100,000 people with moderate or severe disabilities who were not receiving any public or private services funded by the MSSS. It was estimated that if this trend continued over time, this number would reach 115,000 people by 2021. The proportion of seniors with altered health status and loss of autonomy, as well as the severity of both conditions, increased with the pandemic (see Figure 1), resulting in an increased need for home support services and care, and probably accentuated the number and proportion of seniors requiring needed services and care but not receiving them.
The pandemic has created difficulties in maintaining the services and supportive care in the home provided by professionals in the HSS and non-HSS community networks due to social and physical distancing, infection control, lack of personnel and fear of contact with outside workers. In addition, FCs may now find themselves in a situation of physical and psychological exhaustion due to overstretch during the first wave of the pandemic, leading to an alteration in their health status, which exposes them to the same consequences as those affecting seniors, especially if they are elderly (see Figure 1). Supporting FCs is therefore a social, political and economic necessity because of their growing numbers, the difficulties they face and the importance of their key role both with the seniors being cared for and as partners in community home support networks.
Post first wave of the pandemic
We therefore find ourselves today in a situation where there are: (1) an increased number of seniors whose health status has been altered by the pandemic, in a situation of increasing loss of autonomy, requiring home support services and care to combat the progression of their loss of autonomy and the occurrence of related complications (Cf. Figure 1), and at the same time (2) FCs and community-based organizations providing home support to seniors who have been weakened by this pandemic, no longer able to maintain the level of services and care they provided before.
It is therefore crucial today to implement innovative solutions to fight against – that is to say, to avoid, delay or slow down – the deterioration of physical and mental health, the progression of loss of autonomy and the social isolation of seniors made vulnerable by the pandemic due to COVID-19, in order to improve their quality of life and their social inclusion, and thus maintain the Quebec social dynamic of living together. To make these solutions effective and efficient, they must be: (1) complementary to those already in place by FCs and community-based organizations providing home support resources for seniors, (2) co-developed in close collaboration with these actors and the seniors themselves for better approval, and (3) integrable into the continuum of home support services and care (Cf. Figure 1).
Socio-geriatric assessment (ESOGER)
In the midst of the health crisis caused by the first wave of the pandemic due to COVID-19 and during the home confinement of seniors, two actions seemed to us to be a priority (1) the identification of vulnerable seniors most at risk of complications (Cf. Figure 1) associated with (2) the implementation of curative and preventive interventions according to an accelerated procedure. It is with this goal in mind and based on the conclusions of the INESSS that we have designed and made available to community networks working with seniors a Socio-Geriatric Assessment tool called “ESOGER”. This tool takes the form of a simple questionnaire, accessible on a secure digital platform. ESOGER allows for rapid and remote assessment and intervention during a phone call by a community-based agency worker with the senior and/or a FC by: (1) determining whether essential health and social needs are being met and whether there is a disruption or risk of disruption in coverage of these needs, and by (2) providing recommendations for interventions to be implemented to address the disruption in coverage of essential needs and/or related complications. Between April and October 2020, nearly 7,500 logins were recorded on the ESOGER digital platform. More than 2,000 gave their consent for the data entered to be used for research purposes.
Findings from ESOGER
In order to better face the pandemic due to COVID-19 and possible subsequent waves, it is important to draw conclusions from the actions implemented during the first wave and to improve them, in order to limit the progression and consequences of the alteration of health and loss of autonomy of seniors (Cf. Figure 1). At the end of the first wave, ESOGER appears to be a relevant tool for identification and intervention, based on a new approach to home support services and care, known as “telepractice”, which makes it possible to combat the progression of deterioration in physical and mental health, the progression of loss of autonomy, and the social isolation of seniors and its related consequences (see Figure 1). The use of ESOGER in the first wave by community organizations also demonstrated the possibilities of its integration into the continuum of home care services and support. Finally, the interest and usefulness of ESOGER were recently emphasized by the MSSS, which has been recommending the use of this tool in the SAPA programs and services in Quebec since October 2020.
ESOGER must be an effective and efficient clinical tool for (a) identifying the “right senior” – i.e., the most vulnerable and therefore at risk – and doing so at the “right time” – i.e., as soon as possible (i.e., the proactive approach recommended by the INESSS); and (b) proposing the “right interventions” – i.e., those that will be approved by the senior and that will be accessible and able to be integrated into the continuum of support resources already in place at home.
We formalize the hypothesis that ESOGER is: (1) a clinical tool to identify seniors’ frailty in its main dimensions (i.e., (2) a new approach to the use of home support services and care, called “telepractice”, based on interventions that effectively combat the progression of physical and mental health impairment, loss of autonomy, and social isolation during periods of confinement (see Figure 1); (3) a solution that keeps seniors in better health, with a better quality of life, and promotes their social inclusion.
The objective of this study is to examine the effects of ESOGER on the physical and mental health status, loss of autonomy, social isolation, quality of life, and consumption of HSS services and care resources of seniors living at home in the CCSMTL territory and their family caregivers.