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Hamouda I, Baumstarck K, Aim MA, Beltran Anzola A, Loundou A, Billette de Villemeur T, Boyer L, Auquier P, Rousseau MC. Mortality in French people with polyhandicap/profound intellectual and multiple disabilities. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:985-996. [PMID: 38693627 DOI: 10.1111/jir.13138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 02/13/2024] [Accepted: 03/07/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND In recent decades, progress has been made in the care of people with polyhandicap/profound intellectual and multiple disabilities (PIMD) through a better understanding of the pathophysiology and the development of new care management and rehabilitation strategies adapted to these extreme pathologies. Although there is a lack of knowledge about the health status and care management of the oldest people, a better understanding of the natural course of life of people with polyhandicap/PIMD would consequently allow the optimisation of preventive and curative care management strategies. Few robust data on mortality and life expectancy have been documented for this population in France. Our aims are to estimate the median survival time and assess the factors associated with mortality in people with polyhandicap/PIMD receiving care in France. METHODS This study included people with polyhandicap/PIMD, followed by the French national cohort 'Eval-PLH' since 2015. These individuals were included in specialised rehabilitation centres and residential institutions. The people included in the first wave of the cohort (2015-2016) were eligible for the present study. Vital status on 1 January 2022 (censoring date) was collected in two ways: (1) spontaneous reporting by the participating centre to the coordinating team and (2) systematic checking on the French national death platform. According to the vital status, survival was calculated in years from the date of birth to the date of death or from the date of birth to the censoring date. The factors associated with mortality were evaluated using the Cox proportional regression hazards model. RESULTS Data from 780 individuals aged between 3 and 67 years were analysed. At the censoring date, 176 (22.6%) had died, and the mean survival was 52.8 years (95% confidence interval: 51.1-54.5). Mortality was significantly associated with a progressive aetiology, recurrent pulmonary infections, drug-resistant epilepsy and a higher number of medical devices. CONCLUSIONS This study shows for the first time the survival and impact of factors associated with mortality in people with polyhandicap/PIMD in France.
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Affiliation(s)
- I Hamouda
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - K Baumstarck
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - M-A Aim
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
- UR 849, LPS - Social Psychology Laboratory, Aix-Marseille University, Aix-en-Provence, France
| | - A Beltran Anzola
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - A Loundou
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - T Billette de Villemeur
- Sorbonne Université, APHP.SU, Neuropédiatrie - Hôpital Trousseau - La Roche Guyon, Paris, France
| | - L Boyer
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Department of Epidemiology and Health Economics, Assistance Publique des Hôpitaux de Marseille, Marseille, France
| | - P Auquier
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
| | - M-C Rousseau
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix-Marseille University, Marseille, France
- Fédération des Hôpitaux de Polyhandicap et Multihandicap, San Salvadour Hospital, Assistance Publique Hôpitaux de Paris, Hyères, France
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Baumstarck K, Hamouda I, Aim MA, Anzola AB, Khaldi-Cherif S, Felce A, Maincent K, Lind K, Auquier P, Billette de Villemeur T, Rousseau MC. Health care management adequacy among French persons with severe profound intellectual and multiple disabilities: a longitudinal study. BMC Health Serv Res 2024; 24:99. [PMID: 38238747 PMCID: PMC10795329 DOI: 10.1186/s12913-024-10552-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 01/03/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND The care organization of persons with profound intellectual and multiple disabilities (PIMD) varies by country according to the health care system. This study used a large sample of French individuals with severe PIMD/polyhandicap to assess: 1) the adequacy of care setting over a 5-year period and 2) health care consumption. METHODS The longitudinal study used data from the French EVALuation PoLyHandicap (EVAL-PLH) cohort of persons with severe PIMD/polyhandicap who were receiving managed in specialized care centres and residential facilities. Two assessments were performed: wave 1 (T1) in 2015-2016 and wave 2 (T2) in 2020-2021. The inclusion criteria were as follows: age > 3 years at the time of inclusion; age at onset of cerebral lesion younger than 3 years old; and severe PIMD. The adequacy of the care setting was based on the following: i) objective indicators, i.e., adequacy for age and adequacy for health status severity; ii) subjective indicators, i.e., self-perception of the referring physician about medical care adequacy and educational care adequacy. Health care consumption was assessed based on medical and paramedical care. RESULTS Among the 492 persons assessed at the 2 times, 50% of individuals at T1 and 46% of individuals at T2 were in an inadequate care setting based on age and severity. Regarding global subjective inadequacy, the combination of medical adequacy and educational adequacy, 7% of individuals at T1 and 13% of individuals at T2 were in an inadequate care setting. At T2, a majority of individuals were undermonitored by medical care providers (general practitioners, physical medicine rehabilitation physicians, neurologists, orthopaedists, etc.). Important gaps were found between performed and prescribed sessions of various paramedical care (physiotherapy, occupational therapy, psychomotor therapy, etc.). CONCLUSIONS This study revealed key elements of inadequate care management for persons with severe PIMD/polyhandicap in France. Based on these important findings, healthcare workers, familial caregivers, patients experts, and health decision-makers should develop appropriate care organizations to optimize the global care management of these individuals. TRIAL REGISTRATION NCT02400528, registered 27/03/2015.
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Affiliation(s)
- Karine Baumstarck
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France.
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France.
| | - Ilyes Hamouda
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France
| | - Marie-Anastasie Aim
- UR 849, LPS - Social Psychology Laboratory, Aix-Marseille University, 29 Av. Robert Schuman, 13621, Aix-en-Provence, France
| | - Any Beltran Anzola
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
| | - Sherezad Khaldi-Cherif
- General Union Health Insurance Fund (Union Générale Caisse Assurance Maladie, UGECAM), 26-50 Avenue du Professeur-André-Lemierre, 75986, Paris, Ile de France, France
| | - Agnès Felce
- Hendaye Hospital, Route Corniche, 64700, Hendaye, Assistance Publique-Hôpitaux de Paris, France
| | - Kim Maincent
- Committee for Studies, Education and Care for People With Multiple Disabilities (Comité d'Études, d'Éducation Et de Soins Auprès Des Personnes Polyhandicapées, CESAP), 62 Rue de La Glacière, 75013, Paris, France
| | - Katia Lind
- General Union Health Insurance Fund (Union Générale Caisse Assurance Maladie, UGECAM), 26-50 Avenue du Professeur-André-Lemierre, 75986, Paris, Ile de France, France
| | - Pascal Auquier
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Epidemiology and Health Economy Department, Assistance Publique Hôpitaux de Marseille, 27, Boulevard Jean-Moulin, 13385, Marseille, France
| | - Thierry Billette de Villemeur
- Service de Polyhandicap Pédiatrique, Roche Guyon Hospital, Assistance Publique Hôpitaux de Paris, 1 Rue Justinien Blazy 95780, La Roche-Guyon, France
- Hospital Fédération Des Hôpitaux de Polyhandicap Et Multihandicap, San Salvadour Hospital, Assistance Publique Hôpitaux de Paris, 4312 Rte de L'Almanarre, 83400, Hyères, France
| | - Marie-Christine Rousseau
- EA 3279, CEReSS - Research Centre On Health Services and Quality of Life, Aix Marseille University, 27 Boulevard Jean-Moulin, 13385, Marseille, France
- Hospital Fédération Des Hôpitaux de Polyhandicap Et Multihandicap, San Salvadour Hospital, Assistance Publique Hôpitaux de Paris, 4312 Rte de L'Almanarre, 83400, Hyères, France
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Rousseau MC, Winance M, Baumstarck K. Polyhandicap, profound intellectual multiple disabilities : Concept and definition of a highly specific public health issue. Rev Epidemiol Sante Publique 2023; 71:102184. [PMID: 37918043 DOI: 10.1016/j.respe.2023.102184] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/04/2023] Open
Abstract
OBJECTIVES The concept of polyhandicap first emerged in the late '60s in France, with actually a consensus on its definition. This consensus has yet to be reached internationally. The absence of an international consensus on a definition and name for persons with polyhandicap limits progress in research and health planning for these people. METHODS This article describes the history of the emergence of the concept of polyhandicap in France and internationally. RESULTS The emergence of the concept and definition of polyhandicap is part of the history of the development of special education and care for children with disabilities started at the end of the 19th century and during the first half of the 20th century. In France, between 1970 and 2002, working groups composed of professionals and family associations gradually developed and refined the definition of polyhandicap, differentiating it from other clinical entities such as cerebral palsy. Internationally, the term polyhandicap is used in 4 European countries: in France where it first appeared, in Italy, in French-speaking Belgium, and in French-speaking Switzerland but also outside the EU. Various terms may be used around the world to describe clinical entities similar to polyhandicap; the most frequently used in the literature is the term Profound Intellectual and Multiple Disabilities (PIMD) or PIMD Spectrum which does not systematically refer to an early brain injury. DISCUSSION We are currently in the process of internationalizing the concept and definition of polyhandicap, and hopefully, as was the case for cerebral palsy in the 2000s, the various research teams working on this subject around the world will create collaborations and research networks targeting this specific population. CONCLUSION A consensus around a precise definition of polyhandicap is important to ensure that these people are recognized for their uniqueness and specific qualities and to provide them adapted care.
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Affiliation(s)
- Marie-Christine Rousseau
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix Marseille University, 27 boulevard Jean-Moulin, 13385 Marseille, France; Hôpital San Salvadour, Hospital Fédération des Hôpitaux de Polyhandicap et Multihandicap, University Hospital of Paris, 4312 Rte de l'Almanarre, 83400 Hyères, France.
| | - Myriam Winance
- CERMES3, INSERM, Université Paris Cité, CNRS, EHESS, France
| | - Karine Baumstarck
- EA 3279, CEReSS - Research Centre on Health Services and Quality of Life, Aix Marseille University, 27 boulevard Jean-Moulin, 13385 Marseille, France; Epidemiology and Health Economy Department, Aix Marseille University, 27, boulevard Jean-Moulin, 13385 Marseille, France
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