Elderly Patient at Risk of Loss of Mobility, Exercise - Primary Care, Prevention, Care Pathways

Prevention of Loss of Mobility From a Care Pathway Focused on Exercise and Nutrition in Elderly Patients Over 70 Years, in Primary Care. Cluster Randomized Controlled Trial

Loss of mobility is predictive of a loss of autonomy and is often the first sign of functional decline. Loss of mobility is also associated with poor perceived quality of life, depressive symptoms, high risk of adverse events such as falls and fractures, to an increased risk to input in institution and mortality's increase.

Consequences and frequency of loss of mobility make essential its identification, evaluation and the practice of preventive measures in primary care.

The implementation of effective interventions in primary care to prevent or delay the loss of mobility is a public health priority.

PRISME-3P program aims to develop and evaluate a dedicated care pathway, in primary care, based on a personalized multimodal intervention: screening, support combining physician, teaching exercises by a specialized Monitor in Adapted Physical Activities (MAPA) and nutritional counseling.

Inclusion Criteria:

• Aged > 70 years

• With at least 2 of the following signs:

  1. Difficulty in carrying a shopping bag (load about 4.5 Kg)
  2. Difficulty in getting up from a chair without using arms
  3. Difficulty in climbing 10 stairs
  4. Difficulty in moving, walking slow
  5. Difficulty in walking more than 400 meters without stop
  6. Running time <1 hour / week
  7. Fatigue at modest physical effort: shopping, housework ...
  8. At least two falls in the last year
  9. Weight loss ≥5% in 1 month or weight loss ≥10% in 6 months

• Short Physical Performance Battery score < 10

Exclusion Criteria:

• Locomotor disability not allowing implementation of the protocol according to the investigator
• Life expectancy less than 6 months
• Severe chronic progressive pathologies incompatible with the completion of the physical activity program
• Patient institutionalized in nursing homes
• Advanced Cognitive impairment (MMSE <20)