Results of the project Mapéru : Care of Alzheimer’s disease in rural areas Mickaël Blanchet Scientific Council of Fondation Plan Alzheimer jeudi 9 janvier Paris

Advisor : Professor Christian Pihet, University of Angers Realization : Mickaël Blanchet, Post-doctorate, University of Angers Summary : A- Before the Mapéru project B- Context, objectives, territories of study and methodology C- Results :  Detection and diagnosis of Alzheimer’s disease in rural areas  Territorialization and development of policies of Alzheimer on territories  Local care of Alzheimer’s disease : professional coordination and interactions with informals caregivers and patients C- Conclusion, perspectives and future project

A-Before the Mapéru Project

B- Context, objectives, target areas and methodology

Interactions -Access to detection and diagnosis -Deployment and territorialization of Alzheimer’s Policies - Local care of the Alzheimer’s disease in rural areas Spatial distribution of patients and their needs Geography Alzheimer policies

Location of target areas and age demographics within those areas Source : INSEE RGP 2008 Map localization of departement of study West rural territories of study East rural territories of study

Epidemiologic, demographic, medical and social survey completed by a mapping work Interviews with institutions : Regional Agences of Health and General Councils (9) Interviews with professionals localized on target areas (32) Interviews with the main caregivers (30) Methodology :

C-Results Detection and diagnosis of Alzheimer’s disease in target areas

Epidemiologic extrapolation PAQUID cohort ( Dartigues, from 1988 until present ) Eurodem Synthesis (Hofman and al, 1991) Medical data available Drugs consummation Long disease category source : National health insurance Census of patients in : -Hospital - Old people’s home medicalized - Nursing home service - Services of orientation All the departments of study All rural territories of study Unequal rates on territoriesGap

C-Results Territorialization and development of Alzheimer’s policies on territories

regulate Regional Agency of Health (HPST Law, in application since 2011) Fusion of medical and medico-social sectors Principles of contractualization and concurrence Intention to adapt services to individuals needs Third Plan Alzheimer Research development Development and specialization of the offers of services Attention to informals caregivers Creation of MAIA : new device for professional coordination 1- A strengthening of Regional Agency of Health 2- A better efficiency and cooperation on territories 3- Unequal deployment of Alzheimer’s care services on territories

Location of sites specialized care sites for Alzheimer's disease in the departments and target areas(2013) sources : DREES, mission pilotage Plan Alzheimer, INSEE, 2008 Kind of services specialized on Alzheimer’s care Types of services specialized in Alzheimer’s care

C-Results Local care of Alzheimer’s disease : professional coordination and interactions between professionals, informals caregivers and patients

Dependence Allocation Social home help Nursing Home Accomodate places for days/nights Temporary Home Allocation dependance + Health funds (Ald 15) Social home help Nursing Home Medical equipment Home adaptation High level of resort Low level of resort disease progression no resort to allocation Social home help Nursing Home number of case : 13 number of case : 7 number of case :

Localization of rural target areas in relation to urban space bordering

D- Conclusion, perspectives and future project

The gap between cohorts, datas of health national insurance and local census in rural areas The role of general practicionner and family’s proximity for the diagnosis time spent in rural areas New health policies with paradoxal effects The inadequacy in rural areas of the local answers for the care become extensive Conclusion :

Thank you for your attention Mickaël Blanchet