AUDACE: AUtonome à Domicile grâce à un Appareil Connecté et à un suivi Ergo

In the context of an ageing population, where the majority of elderly individuals experiencing a loss of autonomy express a strong desire to remain in their own homes for as long as possible, occupational therapists are playing an increasingly significant role in the healthcare system. Occupational therapy supports individuals in maintaining or recovering their abilities and developing new skills, enabling them to participate in meaningful activities that align with their life goals, particularly when they continue living at home. In Belgium, the non-profit organisation Ergo 2.0 offers at-home support through occupational therapists, coupled with the use of connected devices such as indoor and outdoor geolocation systems, targeted lighting, and rapid fall detection. These solutions aim to enhance safety, reassure both the elderly and their caregivers, and promote mobility, as part of the "Bien chez moi 2.0" programme. This programme operates in the Walloon Region and Brussels Capital, with 3,900 interventions funded by the Walloon Agency for a Quality Life (AVIQ). Occupational therapists collect data through scales and questionnaires in routine care to continuously improve the programme. The research question seeks to evaluate the "Bien chez moi 2.0" programme using the AUDACE evaluation method. It hypothesises that the combination of occupational therapy support and connected devices can increase the sense of security for elderly individuals at risk of losing autonomy while also reassuring both informal and professional caregivers. This approach is expected to improve quality of life, maintain or enhance autonomy, delay potential institutionalisation, and reduce the use of low-value healthcare services, such as preventable hospital readmissions and emergency visits. The key research question is: how, for whom, and under what conditions do these technological solutions, integrated with occupational therapy support, allow elderly individuals to remain at home? The evaluation follows a realist mixed-methods approach and comprises five interrelated parts, each corresponding to sub-research questions and work packages. The first work package (WP1a) involves a qualitative study using semi-structured interviews with approximately thirty elderly individuals living at home to explore their experiences of pre-frailty and the transitions they have faced throughout the frailty continuum. Additionally, interviews with ten individuals will examine the impact of therapeutic education on maintaining autonomy. WP2 uses focus groups with occupational therapists from the "Bien chez moi 2.0" programme, employing a realist approach to identify emerging patterns within context-mechanism-outcome configurations (CMO) to understand the inclusion process and its successes or challenges. WP1b and WP3 involve a prospective cohort study, lasting a maximum of 18 months, to assess elderly participants at risk of losing autonomy. Evaluations will occur at six months after inclusion and will continue if follow-up permits. Data will include measures of autonomy risk, satisfaction, therapeutic goal performance, concerns about falling, health-related quality of life, and hospital or institutionalisation rates. WP4, a multiple embedded case study, will investigate five local areas where occupational therapists operate, examining factors that affect programme implementation. Finally, WP5 will use practice community meetings, informed by interim results from other work packages, to identify and share best practices, with a particular focus on ethical issues.

Affiliations

UCLouvainSSS/IRSS - Institut de recherche santé et société

Citations

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Pierucci, A., Alvarez Irusta, L., de la Croix, T., Ledoux, A., & Van Durme, T. (2024). AUDACE: AUtonome à Domicile grâce à un Appareil Connecté et à un suivi Ergo. Open Science Framework, 80. https://doi.org/10.17605/OSF.IO/BWE63 (Original work published 2024)