PREPA PREvention of Loss of Autonomy
PREPA PREvention of Loss of Autonomy
According to several reports, the percentage of persons aged of more than 80 years is going
 to be doubled for the 25 years, to reach 10 % of the population. This implies an adaptation
 of practices of taken care for elderly people. Furthermore, the expectancy of life without
 any disability at 65 years old is 10.4 years and remains much lower than the general
 expectancy of life, which is of 24.4 years for women and 19.1 years for men.

 Among predictive factors of loss of autonomy, the loss of mobility and muscular weakness are
 major components (OR=3.28 up to 3 years). These two factors are the origins for disabilities
 being responsible of falls, fractures, which lead to quality of life diminution, and increase
 of mortality.

 The only components easily employed in a preventive manner and which have proved their
 efficacy are physical exercise and nutrition. But programs nowadays are still not implemented
 into primary taken care.

 A multimodal program including these two components for patients at risk of loss of mobility
 is an imperative of public health.
Two groups will be identified :

 A first group with a SPPB (Short physical performance battery) score between 8 and 10 and
 walking more than 90 minutes per week. They will be asked to carry out 2 to 3 times a week a
 series of exercises concerning the main muscle groups, using bodyweight, and without specific
 equipment. An activity booklet will be given as support. In a complementary way, individual
 objectives will be established to develop endurance by fighting against hyper-sedentariness
 based on simple advice to the patient and his entourage. The volume of physical activity will
 be developed from activities of daily living. A telephone coaching will be carried out every
 4 weeks by a Adapted Physical Activity Monitor and a precise evaluation of the physical
 performances will be carried out at 3 months.

 A second group for patients with Short physical performance battery ≤ 8 or if >8 but
 excessive sedentary walking less than 90 minutes per week, including running, or having
 sarcopenia criteria.

 They will be offered bi-weekly care by a Adapted Physical Activity Monitor. Training will be
 conducted either in small group programs or at home (if unable to attend), at the frequency
 of 2 sessions per week for 10 weeks. The personalized program of muscular reinforcement will
 be of progressive intensity with and without additional load and with very simple and easily
 usable devices including at home (elastic bands, weights. . . ).

 During the dedicated geriatric consultation, the nutritional status will also be evaluated by
 a food survey and biological samples in order to measure the usual serum nutritional markers.
 The objective of the assessment is to ensure an adequate intake of macro nutrients, including
 proteins, and energy; as well as micronutrient fruits and vegetables rich in antioxidants and
 omega 3 fatty acids which also have a significant impact in terms of prevention and muscle
 function.

 Loss of autonomy : (ADL) Activities of Daily Living score will be calculated. This validated
 scale requires 3 evaluations spread over time. A score > 6 indicates an addiction.

 (Instrumental Activities of Daily Living) Lawton's IADL scale is essentially focused on the
 person's usual behaviour and essentially assesses a patient's level of dependence through the
 assessment of activities of daily living.

 Useful for assessing the patient's state of functional autonomy and deciding on appropriate
 aids (meals at home, household helper, life support, legal protection).
Inclusion Criteria:

 -  Elder people aged of ≥ 70 years

 -  With at least two of the following signs :

 -  Difficulty to stand up from a chair without using arms

 -  Difficulty to climb a floor (10 steps)

 -  Difficulty to move, slow walk

 -  Difficulty to walk more than 400 meters without any stop

 -  Walk activity less than 1h per week

 -  Tiredness whilst doing moderate physical activities : home cleaning, shopping

 -  A least two falls during last year

 -  Unintentional loss of weight: loss of ≥ 5 % in one month, ≥ 10 % in 6 months, or
 BMI< 21kg/m2

 -  Short Physical Performance Battery (SPPB) score < 10 or Hand Grip < 16 kg for women
 and< 26 kg for men

 Exclusion Criteria:

 -  Patient unable to express his participation refusal and under curators or unforced by
 the court of justice

 -  Locomotor disability

 -  expectancy of life being under 12 months