Sentinels of the Social geriatric program: implementation in rural areas of network for the identification of seniors at rick secondary to loss of autonomy or cognitve deficits

Abstract

AbstractBackgroundIn a large rural area, isolated seniors rarely consult health services and often come to emergency rooms after severe deterioration. The implantation of “sentinels” in their environment could make it possible to identify them early.MethodThe AGE Foundation, a charitable organization, in collaboration with the public health services of the Granit region (22,000 p/2731 Km2) in the province of Quebec developed care trajectories, identified caregaps and environments requiring sentinels. The project include the analysis of the implantation and the identified casesResultIn 2022, the nurse “navigator” trains 80 sentinels in the use of tracking tools such as AD‐Plus. The sentinels are home care workers and non‐professionals (hairdresser, grocer, municipal agents, etc.) well established in 16 communities. In 9 months they have raised more and more alerts, from 2 to 25 per month for a total of 129. The alerts concerned seniors with an average age of 79, 56 were between 80 and 89 years old and 18 over 90 years old. The majority, 66%, are women. But more importantly, 73% had no follow‐up in the health system before. They required an average of 20 days of targeted interventions, the vast majority of which took place at home.ConclusionMany seniors suffer from loneliness. At the beginning of loss of independence or cognitive impairment, do not consult health services. The “Sentinels” and the Navigator present an effective tracking model.