KArukera Study of Ageing in Foster Families

Foster care for dependent older people could be a viable alternative to nursing homes. While this type of accommodation appears to be less expensive than living in a geriatric institution, few scientific studies have been able to assess its effectiveness and efficiency. In Guadeloupe, in the French West Indies, nearly 300 dependent older people are cared for by foster families. The aim of the Karukera Study of Ageing in Foster Families (KASAF) is to study the care pathways of dependent elderly people in foster care over a year. The main objective will be to obtain the annual rate of hospitalisation in this setting. The secondary objectives will be to assess hospitalisations costs, the incidence of mortality, the prevalence of geriatric syndromes, as well as the quality of life of residents and foster caregiver burnout. Ultimately, these results will be compared to a similar study in nursing homes, the KASEHPAD study (for Karukera Study of Aging in Nursing Homes).

Foster care for older people is an alternative solution to nursing homes, where the resident, while still moving out of his/her own home, is taken care of within the foster family instead of a collective setting. Foster caregivers, after getting official approval and attending a 20-hour training course, usually accommodate 1 to 3 people in exchange for a monthly fee. Their mission is to ensure the well-being of their residents, and to enable them to maintain close social and family relationships. Other professionals may also provide additional nursing care if necessary. Little is known about the characteristics of foster caregivers and their residents. Epidemiological and medico-economic data on older people in foster families are essential to assess the relevance of this type of care, and several and yet unanswered questions come to mind: what is the residents' annual hospitalization rate and the associated costs? What is the prevalence of geriatric syndromes in this population, and the incidence of mortality? What is the incidence of pneumonia, the leading cause of death and emergency hospitalization in older people? What is the quality of life of the older residents and their foster caregivers? KASAF, an epidemiological cohort, aims to answer these questions. This longitudinal study will assess the health status and medical and economic data of 250 foster family residents and their foster caregivers over a year. A similar study (KASEHPAD, for Karukera Study of Aging in Nursing Homes) will be conducted simultaneously among 500 nursing home residents, as to compare these two types of care.

The main outcome is the number of hospitalizations over a year. Local PMSI (Medicalization program of the information system) hospitals databases will provide information on hospital admissions.

250 people aged 60 and older and living in foster families in Guadeloupe will be included. Data collection will be conducted using face-to-face interviews with the participants and their foster caregivers at baseline and after 6 and 12 months, and phone interviews with the foster caregivers, after 3 and 9 months. Anthropometric measures, information on general health status and care pathways (hospitalization, medical and paramedical consultations), as well as data on medical history, cognition, nutritional status, and physical frailty will also be collected. Depressive and anxiety symptoms will also be assessed along with functional abilities (mobility, instrumental activities of daily living and activities of daily living). A systematic update of vital status (death) and care pathway will be carried out at each follow-up. Additional information on the residents' living status and potential hospitalizations will be collected after 3 and 9 months. Finally, foster caregivers will be interviewed at inclusion, after 6 months and after a year to assess their own quality of life and burnout symptoms.

This study was supported by a grant from the Conseil Départemental de la Guadeloupe, Saint-Martin and Saint-Barthélemy.

Eligibility Criteria:
Inclusion Criteria:

* participant must be over 60 years old
* residents must live in a foster family in Guadeloupe, Saint-Martin or Saint-Barthelemy
* residents must benefit from the French social security
* Participant must have an identified support person
* Participant under guardianship or curatorship if accepted by the legal guardian
* Participant in a foreseeable short-term end-of-life situation if accepted by the legal representative or the support person

Exclusion Criteria:

* refusal from the resident or his legal guardian to participate in the study