Implementation of a Territorial Geriatric Hotline in Southwestern France: A monocentric observational study to improve access to geriatric expertise

Implementation of a Territorial Geriatric Hotline in Southwestern France: A monocentric observational study to improve access to geriatric expertise | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Implementation of a Territorial Geriatric Hotline in Southwestern France: A monocentric observational study to improve access to geriatric expertise Eva Peyrusqué, Sophie Elmalem, Xavier Dubucs, Manon Roussel, Yves Rolland, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8873768/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background: France is experiencing rapid population aging, increasing demand for healthcare services and pressure on unscheduled care pathways for frail and multimorbid older adults. Many transfers to acute care, including emergency departments, may be avoidable with timely geriatric expertise. In 2024, a territorial geriatric hotline was implemented at Toulouse University Hospital to provide community-based physicians with rapid access to geriatric advice and optimize patient care pathways. The purpose of this study was to describe the development, implementation, and early activity of a territorial geriatric hotline for community-based physicians and assess its feasibility and impact on patient orientation. Methods: We conducted a monocentric, observational, descriptive study of the Haute-Garonne territorial geriatric hotline (June 2024–November 2025). The hotline was developed with 15 local professional healthcare networks and provided rapid access to geriatricians for general practitioners. Only calls requesting general geriatric advice or hospitalization were analyzed; calls related to supra-specialty expertise (onco-geriatrics, cardio-geriatrics, dementia care and palliative care) were redirected internally. Data collected included patient characteristics, reasons for the call, and patient orientation. Analyses were descriptive. Results: During 18 months, 3,626 calls were received, with monthly activity increasing from 100 to 425 calls. A total of 393 calls with complete data were analyzed (mean age 84.3 ± 7.6 years; 55.5% women), placed by 243 general practitioners. Common reasons for calls included impaired general condition (19.3%), falls (12.5%), neurodegenerative diseases (11.2%), hematology/onco-geriatrics (10.4%), nutrition/metabolic disorders (9.4%), and pain (8.1%). Following calls, patient orientation included hospitalization in an acute geriatric unit (35.4%), provision of geriatric advice (27.2%), day hospital admission (16.0%), reorientation to another care pathway (7.6%), and emergency department referral (7.4%). Conclusion: A territorial geriatric hotline integrated into local professional healthcare networks is feasible and widely utilized. It facilitates rapid access to geriatric expertise, improves patient orientation, and supports alternatives to emergency department transfers. The model demonstrates how limited geriatric resources can be leveraged to strengthen interprofessional coordination, optimize care pathways, and enhance equity in access to geriatric care. These results provide a basis for further evaluation of its impact on patient outcomes and healthcare system efficiency. Older adults Primary care physicians Care pathways Healthcare network Figures Figure 1 Figure 2 Figure 3 Figure 4 Background France is undergoing a major demographic shift related to population ageing, with 23.4% of the population expected to be aged 65 years or older by 2030, compared with 20.5% in 2025 ( 1 ). This demographic transition is associated with a growing demand for healthcare services, placing increasing strain on an already fragile healthcare system ( 2 ). As in many Western countries, emergency departments are facing a rising influx of older, frail, and multimorbid patients. This pressure is further exacerbated by a declining medical workforce and healthcare organizations that are poorly adapted to geriatric needs, contributing to emergency department overcrowding ( 3 – 6 ). In France, emergency department transfers among individuals aged 75 years or older increased by 5% in 2024, compared with less than 2% in the general population ( 7 ). A substantial proportion of these transfers (~ 21%), particularly among nursing home residents, are considered inappropriate, meaning that they do not require emergency care and could be managed through alternative care pathways without loss of opportunity. The number of potentially avoidable transfers, resulting from inappropriate care or the absence of preventive measures, is even higher ( 8 ). The lack of a prior clinical assessment is one of the main risk factors for inappropriate emergency transfers ( 9 ). Older adults represent an increasing share of emergency department patients, and frail individuals are particularly vulnerable to negative consequences of prolonged stays ( 10 ). Among patients aged 75 years and older, spending the night in the emergency department while awaiting hospital admission has been associated with a 39% relative increase in in-hospital mortality, a 24% increase in adverse events, and a longer length of stay (9 days versus 8 days ( 11 )). High patient flow can further amplify these effects and sometimes results in care being delivered in suboptimal settings, which may affect comfort, functional independence, and dignity ( 12 ). Prolonged stays also increase the risk of iatrogenic complications, with potential negative consequences for both patients and the healthcare system ( 3 , 10 , 11 , 13 ). These observations highlight the importance of strategies aimed at both preventing avoidable transfers and providing upstream geriatric expertise to support appropriate emergency department use. Several studies have demonstrated the effectiveness of alternatives to emergency department transfers for older adults when advanced technical resources or emergency physician expertise are not required. In France, a multicenter study conducted in seven hospitals showed that access to geriatric expertise helped avoid emergency department transfers in nearly two-thirds of cases ( 14 ). Internationally, the British “Silver Triage” model and Canadian experiences in community paramedicine have similarly shown that rapid access to geriatric expertise promotes safe and appropriate alternatives to emergency department ( 15 , 16 ). These experiences highlight the importance of timely access to geriatric expertise, which can support early clinical assessment, appropriate patient orientation, and the use of alternative care pathways when hospital-based emergency care is not required. However, timely access to geriatric expertise remains a major challenge due to medical workforce shortages and demographic changes. In Haute-Garonne, the medical demographic profile is unfavorable, with relatively low general practitioner density and significant territorial disparities ( 17 ). Toulouse alone has approximately 32,920 residents aged 75 years or older, while the entire department counts around 119,000 older adults ( 18 ). These trends increase the risk of limited access to appropriate care for older adults and highlight the need for targeted organizational strategies. In response, several initiatives have been developed in France to provide alternatives to inappropriate emergency department transfers among older adults. Since 2015, reactive day hospitals for nursing home residents ( 19 ) and the GTHP program (Geriatric Team Health Care Pathways; ( 20 )) have offered nursing homes rapid access to geriatric expertise. In 2023 a direct line was implemented allowing emergency physicians to directly consult geriatric specialists for advice on the care of older adults, followed in 2024 by a territorial geriatric hotline at Toulouse University Hospital, providing community-based physicians with direct access to geriatric expertise. These initiatives aim to optimize care coordination, reduce unnecessary emergency transfers, and improve patient safety. This article describes the development, implementation, and operational framework of this territorial geriatric hotline dedicated to general practitioners, and reports its initial results. The primary objective of this initiative was to optimize access to the most tailored and appropriate level of care for older adults. Methods Study design and setting We conducted a monocentric, observational, descriptive study evaluating the implementation and early activity of a territorial geriatric hotline in the Haute-Garonne department (Occitania, southwestern France; Fig. 1). The department covers nearly one million inhabitants and includes both urban and semi-rural areas. The study period was from June 2024 to November 2025. The hotline consisted of a dedicated telephone line available to general practitioners, operating five days per week during daytime hours, and was designed to provide rapid access to geriatric expertise for older adults (aged 65 years and above) at the territorial level. The objectives of this intervention were to improve timely access to geriatric expertise for community-based physicians, support clinical decision-making for older adults requiring unscheduled care, facilitate appropriate orientation toward inpatient, outpatient, or community-based care pathways, centralize access to existing geriatric resources, and promote alternatives to emergency department transfers when appropriate. Territorial implementation and partners The intervention was co-developed with 15 local professional healthcare networks (Appendix 1) covering general practitioners in the Haute-Garonne department. Among the approximately 1,452 general practitioners practicing in the department, about 20% (n = 290) were affiliated with these networks and constituted the potential pool of physicians eligible to access the hotline. All local professional healthcare networks were involved from the design phase onward to ensure alignment with local practices and territorial needs. Kick-off meetings were organized in June 2024, followed by follow-up meetings at 3 months (September 2024), 6 months (January 2025), and 12 months (June 2025) to adapt the operational framework and incorporate feedback from local professional healthcare networks representatives. Communication and stakeholder engagement An informational leaflet describing the hotline and its operational modalities was developed (Fig. 2) and disseminated to all geriatric care facilities, partner private clinics, and local professional healthcare networks within the territory. A directory of key contacts within each network was also created to support interprofessional communication. The project was presented to the geriatric department of Toulouse University Hospital and to eight partner private clinics (Appendix 2). Public and private healthcare institutions committed to supporting the intervention by facilitating patient admissions, outpatient and day hospital care, and direct hospital admissions, with regular updates of bed availability to optimize patient orientation. Regular meetings with the Regional Health Agency addressed the relevance and sustainability of the intervention. Call regulation and governance were centrally managed by Toulouse University Hospital. Organization and operational framework The hotline team consisted of two senior geriatricians, a project manager overseeing operational coordination, and a medical secretary responsible for call tracking and follow-up. The hotline was accessible via a single dedicated phone number from Monday to Friday, 9:00 a.m. to 6:00 p.m. Calls were routed through an interactive voice response system offering six entry points: 1. cognitive or behavioral disorders, 2. cardio-geriatrics, 3. onco-geriatrics, 4. pain management and palliative care, 5. geriatric advice or a hospitalization request, 6. schedule a consultation appointment (Fig. 3). Depending on clinical needs, callers received either specialized geriatric advice (options 1–4) or general geriatric advice (option 5). Responses could include telephone consultation, teleconsultation or tele-expertise, outpatient consultation, day hospital admission, direct short-stay hospitalization, or redirection to another appropriate care pathway. The intervention relies on the university hospital’s electronic medical record and clinical information systems, which facilitate patient orientation toward appropriate care facilities based on medical profile, real-time availability, and geographic location. Variables For each call to the geriatric hotline (entry point 5), the following data were routinely collected: 1) Patient characteristics: age, sex and referral source (attending physician or other) ; 2) Reason for the call: categorized into impairment of general condition, falls, neurodegenerative diseases, hematology/oncogeriatrics, nutrition/metabolic disorders, pain, social issues, cardiogeriatrics, gastroenterology, pulmonology, dermatology, infectious diseases, palliative care, drugs/other advice, or other conditions ; 3) Patient orientation following the call: hospitalization in an acute geriatric care unit, provision of geriatric advice, day hospital admission, outpatient consultation, reorientation to another care pathway, referral to the emergency department, other solutions, no solution, referral back to the attending physician, or teleconsultation. Calls to entry points 1–4 (cognitive/behavioral disorders, cardio-geriatrics, onco-geriatrics, pain/palliative care) and 6 (consultation appointment requests) were redirected internally to the corresponding specialty teams at the University Hospital and are not included in this analysis. All variables were pre-defined, and categorical outcomes were assigned by the geriatrician handling the call or by the medical secretary in charge of that line. Study size The study size included all calls received during the 18-month period (June 2024 – November 2025). No a priori sample size calculation was performed due to the descriptive nature of the study. Data collection and analysis A dedicated traceability system was used to routinely collect data at the time of each call. All calls initiated by community-based general practitioners during the study period were eligible. Calls that were incomplete or duplicated were excluded from the analysis. Analyses were purely descriptive and are presented as means with standard deviations for continuous variables and as proportions for categorical variables. Ethics In accordance with French ethical and regulatory law (Code de la Santé Publique), this prospective study based on routine care data did not require formal approval from a national ethics committee but was conducted under the reference methodology MR-004 of the Commission Nationale de l’Informatique et des Libertés (CNIL). The study protocol was reviewed and authorized by the Ethics Committee of Toulouse University Hospital, which confirmed compliance with national regulations (approval number #RnIPH 2025-76). Toulouse University Hospital declared compliance with CNIL reference methodology MR-004. In accordance with French regulations, patients were informed of the study and of their right to object to the use of their data for research purposes. No opposition was recorded. Therefore, written informed consent was not required under national legislation. The study was conducted in accordance with the Declaration of Helsinki. Results Call volume and trends During the 18 months of operation (June 2024 to November 2025), the hotline received a total of 3,626 calls, corresponding to a monthly average of 201 calls. Activity progressively increased over time, peaking at 425 calls in November 2025, compared with 100 calls during the first month of operation (June 2024; Fig. 4). Call distribution by thematic category Overall call distribution through the hotline’s interactive voice response system showed a predominance of requests for general geriatric advice (1,789 calls, 49%), followed by cognitive or behavioral disorders (802 calls, 22%), onco-geriatrics (615 calls, 17%), cardio-geriatrics (255 calls, 7%), palliative care (81 calls, 2%; hotline launched March 2025), and consultation appointment requests (85 calls, 2%; Fig. 4). Patient characteristics and call reasons (entry option 5) Among these 1,789 calls, 393 calls were included in the analysis of patient characteristics and call reasons. These calls corresponded to cases where complete data were available, as documentation was dependent on geriatricians or the medical secretary, and not all calls were fully recorded. In addition, multiple calls regarding the same patient were counted only once in the analysis to avoid duplication. Among the 393 analyzed calls, the mean patient age was 84.25 ± 7.62 years, 55.5% were women, and the majority of calls originated from attending physicians (91.9%). The most frequent reasons for calling were impairment of general condition (19.3%), falls (12.5%), neurodegenerative diseases (11.2%), hematology/oncogeriatrics (10.4%), nutrition/metabolic disorders (9.4%), pain (8.1%), social issues (7.9%), and cardiogeriatrics (6.1%). Less frequent reasons (< 3%) included gastroenterology, pulmonology, drug-related issues, infectious diseases, dermatology, palliative care, and other conditions (Table 1 ). Calls were placed by approximately 243 unique general practitioners, each counted once regardless of repeated use of the hotline. Patient orientation following the call Following the call, patient orientation most frequently resulted in hospitalization in an acute geriatric care unit (35.4%), followed by provision of geriatric advice (27.2%), referral to a day hospital (16.0%), reorientation to another care pathway (7.6%), and referral to the emergency department (7.4%). Other outcomes included alternative solutions (2.8%), scheduling of an outpatient consultation (1.8%), no solution identified (0.8%), referral back to the attending physician (0.8%), and teleconsultation (0.3%; Table 1 ). Table 1 General characteristics (n = 393) Women (n ; %) 218 (55.5%) Age (years) 84.25 ± 7.62 Referral source: attending physician (n; %) 361 (91.9%) Reason for the call (n = 393) Impairment of the general condition or status 76 (19.3%) Falls 49 (12.5%) Neurodegenerative diseases 44 (11.2%) Hematology / Oncogeriatrics 41 (10.4%) Nutrition and metabolic 37 (9.4%) Pain 32 (8.1%) Social issues 31 (7.9%) Cardiogeriatrics 24 (6.1%) Gastroenterology 13 (3.3%) Other conditions 13 (3.3%) Pulmonology 11 (2.8%) Drugs and other advice 9 (2.3%) Infectious diseases 9 (2.3%) Dermatology 2 (0.5%) Palliative care 2 (0.5%) Patient orientation following the call (n = 393) Hospitalization in an acute geriatric care unit 139 (35.4%) Geriatric advice 107 (27.2%) Day hospital 63 (16.0%) Reorientation 30 (7.6%) Emergency department 29 (7.4%) Other solutions 11 (2.8%) Scheduling of an outpatient consultation 7 (1.8%) No solution 3 (0.8%) Orientation to the attending physician 3 (0.8%) Teleconsultation 1 (0.3%) Discussion Our pilot study demonstrates the feasibility of a territorial geriatric hotline providing rapid access to geriatric expertise for community-based physicians in a population with a growing proportion of older adults. Over 18 months, more than 3,600 calls were recorded, concerning old patients (mean age 84.25 years). Call volume progressively increased over time, reflecting a growing demand from community-based physicians and the successful integration of the hotline into local practice. In more than 90% of cases, an alternative to emergency department transfer was provided, including specialized advice, scheduled hospitalizations, or tailored patient orientation, thereby facilitating more appropriate care pathways and helping to avoid unnecessary emergency department visits. These findings are consistent with previous literature, highlighting that many emergency transfers among older adults could be avoided if geriatric expertise were mobilized in advance. In France, a multicenter study conducted across seven hospitals between April 2018 and April 2020, reported that among more than 4,000 calls, 64% were requests for advice and 36% for hospitalization. Nearly half of the hospitalization requests were directed straight to a geriatric unit, thereby avoiding an emergency department transfer ( 14 ). Our results align with these findings, with the majority of situations guided toward alternatives to emergency care. The mean age in that study was 86.8 years, slightly higher than in our cohort, likely reflecting a higher proportion of institutionalized patients in hospital-centered experiences. By contrast, our model, based within local professional healthcare networks and involving community-based physicians, likely reached more older adults living at home. Compared this multicenter study ( 14 ), the Toulouse hotline serves a larger population with only two geriatricians, coordinated by 15 local networks of healthcare professionals. In contrast, multicenter study involved several hospital teams with dedicated resources and beds. The Toulouse hotline received an average of 201 calls per month, compared with approximately 25 calls per month per center in the multicenter study, reflecting both the size of the population served and the territorial organization. These findings confirm the feasibility of the hotline while highlighting limitations related to medical workforce density and coverage of a large area. We also believe that co-constructing the intervention with local professional healthcare networks facilitated rapid uptake among general practitioners and accelerated changes in usual practice. These initiatives are part of a broader strategy to territorialize healthcare provision and strengthen care coordination, objectives pursued by the 15 local professional healthcare networks in the region, thereby providing older adults with more structured and appropriate access to alternatives to emergency care. This dynamic is also rooted in the COVID-19 pandemic, which demonstrated the relevance and feasibility of geriatric hotlines, particularly for nursing home residents. The Toulouse experience, implemented in 2024, builds on these initiatives while adapting the model to local needs. The GTHP program highlighted the benefits of rapid, coordinated access to geriatric expertise and has since been sustained ( 20 ). These initiatives align with broader goals of territorializing healthcare services and strengthening coordination, enabling older adults to access structured alternatives to emergency care. International experiences also support the value of rapid access to geriatric expertise. In the United Kingdom, the “Silver Triage” model, in which geriatricians provide real-time support to pre-hospital emergency teams, demonstrated that more than 80% of patients were not transported to hospital, with the system considered useful and well accepted by frontline teams ( 15 ). In Canada, community paramedicine programs similarly reduced emergency department use among older adults living at home, illustrating the importance of early, specialized intervention ( 16 ). However, the implementation of these programs can be demanding in terms of organizational and human resources, as highlighted by the Canadian experience, which required extensive coordination, training, and staffing. While these programs target different patient populations, they illustrate the broader principle that rapid access to geriatric expertise, whether through pre-hospital interventions or territorial hotlines, supports prompt and appropriate patient orientation, facilitates direct admissions to geriatric care when needed, and allows timely specialist advice, ultimately enhancing the quality and coordination of care for older adults. This study is characterized by its strong territorial context, implemented in coordination with 15 local professional healthcare networks encompassing approximately 290 general practitioners. The hotline was developed through partnerships with both public and private healthcare sectors. A key strength of our study is its scale and representativeness, covering Toulouse, France’s fourth largest metropolitan area, with over 3,600 calls recorded during 18 months, reflecting substantial engagement from community-based general practitioners. However, this remains a pilot, monocentric, observational study, and we could not directly measure the hotline’s impact on emergency department visits. The availability of geriatricians continues to be a limiting factor for generalization and reproducibility. Looking ahead, the hotline should be considered as a complementary tool alongside other territorial coordination systems, such as Senior Care Access System (SCAS), to facilitate better patient orientation, optimize care pathways, and ensure that patients receive care in the most appropriate setting. Within the framework of this pilot, physician usage and satisfaction with the hotline are currently being evaluated, as is the geographic distribution of requests. Finally, multicenter and prospective studies will be necessary to assess the actual impact of such interventions on quality of life, iatrogenesis, and emergency department workload. It is also essential that these complementary pathways support patient safety without inadvertently delaying or misdirecting care for vulnerable patients. Conclusion This pilot study demonstrates that a territorial geriatric hotline integrated into local professional healthcare networks is feasible and widely utilized, with strong potential to improve patient orientation and provide alternatives to emergency department transfers. Original in its territorial anchoring and in functioning with a limited number of geriatricians, this model illustrates the use of a hotline as a lever to strengthen interprofessional coordination and ensure equitable access to geriatric expertise. It paves the way for new organizational models adapted to demographic transition. Abbreviations GTHP Geriatric Team Health Care Pathways SCAS Senior Care Access System Declarations Ethics approval and consent to participate In accordance with French ethical and regulatory law (Code de la Santé Publique), this prospective study based on routine care data did not require formal approval from a national ethics committee but was conducted under the reference methodology MR-004 of the Commission Nationale de l’Informatique et des Libertés (CNIL). The study protocol was reviewed and authorized by the Ethics Committee of Toulouse University Hospital, which confirmed compliance with national regulations (approval number #RnIPH 2025-76). Toulouse University Hospital declared compliance with CNIL reference methodology MR-004. In accordance with French regulations, patients were informed of the study and of their right to object to the use of their data for research purposes. No opposition was recorded. Therefore, written informed consent was not required under national legislation.The study was conducted in accordance with the Declaration of Helsinki. Consent for publication Not applicable. Funding This work was supported by the Regional Health Agency of Occitanie, France. Author Contribution Peyrusqué E: drafted the article, conception, interpretation of data, analysis; Elmalem S: conception, interpretation of data, reviewing the article; Dubucs X: reviewing the article; Roussel M: reviewing the article; Rolland Y: conception, interpretation of data, reviewing the article; Balardy L: conception, interpretation of data, reviewing the article; Villars H: conception, interpretation of data, reviewing the article. Acknowledgement The authors would like to thank Mr. Lay Nien Sephan for his involvement in this territorial geriatric hotline, as well as all partners from the local professional healthcare networks and clinics for their valuable support. 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Geriatric Team Health Care Pathways: An Organizational Innovation to Enhance Care Pathways of Long-Term Care Facilities’ Residents in the French Region of Occitania. J Am Med Dir Assoc. 2024;25(6):104976. Additional Declarations No competing interests reported. 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University Hospital, IHU HealthAge","correspondingAuthor":false,"prefix":"","firstName":"Yves","middleName":"","lastName":"Rolland","suffix":""},{"id":596312572,"identity":"17d64f28-0367-41f1-996d-9a255d29c441","order_by":5,"name":"Laurent Balardy","email":"","orcid":"","institution":"Gérontopôle of Toulouse, Institute on Aging, Toulouse University Hospital, IHU HealthAge","correspondingAuthor":false,"prefix":"","firstName":"Laurent","middleName":"","lastName":"Balardy","suffix":""},{"id":596312573,"identity":"021407f6-2c91-407a-a103-a9a10c7fe7d3","order_by":6,"name":"Hélène Villars","email":"","orcid":"","institution":"Gérontopôle of Toulouse, Institute on Aging, Toulouse University Hospital, IHU HealthAge","correspondingAuthor":false,"prefix":"","firstName":"Hélène","middleName":"","lastName":"Villars","suffix":""}],"badges":[],"createdAt":"2026-02-13 16:08:30","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8873768/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8873768/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104398867,"identity":"5981b2bf-7338-4039-b722-469999058359","added_by":"auto","created_at":"2026-03-11 12:04:02","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":234624,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8873768/v1/997e87f61f56c97d11b943cb.png"},{"id":104398523,"identity":"d821da93-58b6-4cc3-aa55-949eb9d0e8ac","added_by":"auto","created_at":"2026-03-11 12:02:47","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":327294,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-8873768/v1/f6e0796fb3da467dca2e2efe.png"},{"id":103581138,"identity":"0c61757b-b733-4ceb-b376-4114bec8f4c6","added_by":"auto","created_at":"2026-02-27 10:15:41","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":89517,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage3.png","url":"https://assets-eu.researchsquare.com/files/rs-8873768/v1/a168eb5c3aa4550ceeea25c0.png"},{"id":104398661,"identity":"634247d0-f80c-49e0-8802-baca17f4c3cb","added_by":"auto","created_at":"2026-03-11 12:03:11","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":142044,"visible":true,"origin":"","legend":"\u003cp\u003eSee image above for figure legend.\u003c/p\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e","description":"","filename":"floatimage4.png","url":"https://assets-eu.researchsquare.com/files/rs-8873768/v1/e16cc338d4629a4b06acc3ed.png"},{"id":104407449,"identity":"92c063f9-5378-4d54-bd2d-12dc0e019ebb","added_by":"auto","created_at":"2026-03-11 12:38:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1480150,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8873768/v1/ba30741f-5aba-40bc-9ba4-90fc0ba67770.pdf"},{"id":103581136,"identity":"f562d494-e64c-4e8e-a10a-626054ea362d","added_by":"auto","created_at":"2026-02-27 10:15:41","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":26683,"visible":true,"origin":"","legend":"","description":"","filename":"Appendix.docx","url":"https://assets-eu.researchsquare.com/files/rs-8873768/v1/6519bf3b50eda20545dfb055.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implementation of a Territorial Geriatric Hotline in Southwestern France: A monocentric observational study to improve access to geriatric expertise","fulltext":[{"header":"Background","content":"\u003cp\u003eFrance is undergoing a major demographic shift related to population ageing, with 23.4% of the population expected to be aged 65 years or older by 2030, compared with 20.5% in 2025 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). This demographic transition is associated with a growing demand for healthcare services, placing increasing strain on an already fragile healthcare system (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). As in many Western countries, emergency departments are facing a rising influx of older, frail, and multimorbid patients. This pressure is further exacerbated by a declining medical workforce and healthcare organizations that are poorly adapted to geriatric needs, contributing to emergency department overcrowding (\u003cspan additionalcitationids=\"CR4 CR5\" citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn France, emergency department transfers among individuals aged 75 years or older increased by 5% in 2024, compared with less than 2% in the general population (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). A substantial proportion of these transfers (~\u0026thinsp;21%), particularly among nursing home residents, are considered inappropriate, meaning that they do not require emergency care and could be managed through alternative care pathways without loss of opportunity. The number of potentially avoidable transfers, resulting from inappropriate care or the absence of preventive measures, is even higher (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The lack of a prior clinical assessment is one of the main risk factors for inappropriate emergency transfers (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eOlder adults represent an increasing share of emergency department patients, and frail individuals are particularly vulnerable to negative consequences of prolonged stays (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). Among patients aged 75 years and older, spending the night in the emergency department while awaiting hospital admission has been associated with a 39% relative increase in in-hospital mortality, a 24% increase in adverse events, and a longer length of stay (9 days versus 8 days (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e)).\u003c/p\u003e \u003cp\u003eHigh patient flow can further amplify these effects and sometimes results in care being delivered in suboptimal settings, which may affect comfort, functional independence, and dignity (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Prolonged stays also increase the risk of iatrogenic complications, with potential negative consequences for both patients and the healthcare system (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). These observations highlight the importance of strategies aimed at both preventing avoidable transfers and providing upstream geriatric expertise to support appropriate emergency department use.\u003c/p\u003e \u003cp\u003eSeveral studies have demonstrated the effectiveness of alternatives to emergency department transfers for older adults when advanced technical resources or emergency physician expertise are not required. In France, a multicenter study conducted in seven hospitals showed that access to geriatric expertise helped avoid emergency department transfers in nearly two-thirds of cases (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Internationally, the British \u0026ldquo;Silver Triage\u0026rdquo; model and Canadian experiences in community paramedicine have similarly shown that rapid access to geriatric expertise promotes safe and appropriate alternatives to emergency department (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). These experiences highlight the importance of timely access to geriatric expertise, which can support early clinical assessment, appropriate patient orientation, and the use of alternative care pathways when hospital-based emergency care is not required.\u003c/p\u003e \u003cp\u003eHowever, timely access to geriatric expertise remains a major challenge due to medical workforce shortages and demographic changes. In Haute-Garonne, the medical demographic profile is unfavorable, with relatively low general practitioner density and significant territorial disparities (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). Toulouse alone has approximately 32,920 residents aged 75 years or older, while the entire department counts around 119,000 older adults (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). These trends increase the risk of limited access to appropriate care for older adults and highlight the need for targeted organizational strategies.\u003c/p\u003e \u003cp\u003eIn response, several initiatives have been developed in France to provide alternatives to inappropriate emergency department transfers among older adults. Since 2015, reactive day hospitals for nursing home residents (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e) and the GTHP program (Geriatric Team Health Care Pathways; (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e)) have offered nursing homes rapid access to geriatric expertise.\u003c/p\u003e \u003cp\u003eIn 2023 a direct line was implemented allowing emergency physicians to directly consult geriatric specialists for advice on the care of older adults, followed in 2024 by a territorial geriatric hotline at Toulouse University Hospital, providing community-based physicians with direct access to geriatric expertise. These initiatives aim to optimize care coordination, reduce unnecessary emergency transfers, and improve patient safety.\u003c/p\u003e \u003cp\u003eThis article describes the development, implementation, and operational framework of this territorial geriatric hotline dedicated to general practitioners, and reports its initial results. The primary objective of this initiative was to optimize access to the most tailored and appropriate level of care for older adults.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and setting\u003c/h2\u003e \u003cp\u003eWe conducted a monocentric, observational, descriptive study evaluating the implementation and early activity of a territorial geriatric hotline in the Haute-Garonne department (Occitania, southwestern France; Fig.\u0026nbsp;1). The department covers nearly one million inhabitants and includes both urban and semi-rural areas. The study period was from June 2024 to November 2025.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe hotline consisted of a dedicated telephone line available to general practitioners, operating five days per week during daytime hours, and was designed to provide rapid access to geriatric expertise for older adults (aged 65 years and above) at the territorial level.\u003c/p\u003e \u003cp\u003eThe objectives of this intervention were to improve timely access to geriatric expertise for community-based physicians, support clinical decision-making for older adults requiring unscheduled care, facilitate appropriate orientation toward inpatient, outpatient, or community-based care pathways, centralize access to existing geriatric resources, and promote alternatives to emergency department transfers when appropriate.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTerritorial implementation and partners\u003c/h3\u003e\n\u003cp\u003eThe intervention was co-developed with 15 local professional healthcare networks (Appendix 1) covering general practitioners in the Haute-Garonne department.\u003c/p\u003e \u003cp\u003eAmong the approximately 1,452 general practitioners practicing in the department, about 20% (n\u0026thinsp;=\u0026thinsp;290) were affiliated with these networks and constituted the potential pool of physicians eligible to access the hotline. All local professional healthcare networks were involved from the design phase onward to ensure alignment with local practices and territorial needs.\u003c/p\u003e \u003cp\u003e Kick-off meetings were organized in June 2024, followed by follow-up meetings at 3 months (September 2024), 6 months (January 2025), and 12 months (June 2025) to adapt the operational framework and incorporate feedback from local professional healthcare networks representatives.\u003c/p\u003e\n\u003ch3\u003eCommunication and stakeholder engagement\u003c/h3\u003e\n\u003cp\u003eAn informational leaflet describing the hotline and its operational modalities was developed (Fig.\u0026nbsp;2) and disseminated to all geriatric care facilities, partner private clinics, and local professional healthcare networks within the territory. A directory of key contacts within each network was also created to support interprofessional communication.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe project was presented to the geriatric department of Toulouse University Hospital and to eight partner private clinics (Appendix 2). Public and private healthcare institutions committed to supporting the intervention by facilitating patient admissions, outpatient and day hospital care, and direct hospital admissions, with regular updates of bed availability to optimize patient orientation.\u003c/p\u003e \u003cp\u003eRegular meetings with the Regional Health Agency addressed the relevance and sustainability of the intervention. Call regulation and governance were centrally managed by Toulouse University Hospital.\u003c/p\u003e\n\u003ch3\u003eOrganization and operational framework\u003c/h3\u003e\n\u003cp\u003eThe hotline team consisted of two senior geriatricians, a project manager overseeing operational coordination, and a medical secretary responsible for call tracking and follow-up.\u003c/p\u003e \u003cp\u003e The hotline was accessible via a single dedicated phone number from Monday to Friday, 9:00 a.m. to 6:00 p.m. Calls were routed through an interactive voice response system offering six entry points: 1. cognitive or behavioral disorders, 2. cardio-geriatrics, 3. onco-geriatrics, 4. pain management and palliative care, 5. geriatric advice or a hospitalization request, 6. schedule a consultation appointment (Fig.\u0026nbsp;3).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eDepending on clinical needs, callers received either specialized geriatric advice (options 1\u0026ndash;4) or general geriatric advice (option 5). Responses could include telephone consultation, teleconsultation or tele-expertise, outpatient consultation, day hospital admission, direct short-stay hospitalization, or redirection to another appropriate care pathway.\u003c/p\u003e \u003cp\u003eThe intervention relies on the university hospital\u0026rsquo;s electronic medical record and clinical information systems, which facilitate patient orientation toward appropriate care facilities based on medical profile, real-time availability, and geographic location.\u003c/p\u003e\n\u003ch3\u003eVariables\u003c/h3\u003e\n\u003cp\u003eFor each call to the geriatric hotline (entry point 5), the following data were routinely collected: 1) Patient characteristics: age, sex and referral source (attending physician or other) ; 2) Reason for the call: categorized into impairment of general condition, falls, neurodegenerative diseases, hematology/oncogeriatrics, nutrition/metabolic disorders, pain, social issues, cardiogeriatrics, gastroenterology, pulmonology, dermatology, infectious diseases, palliative care, drugs/other advice, or other conditions ; 3) Patient orientation following the call: hospitalization in an acute geriatric care unit, provision of geriatric advice, day hospital admission, outpatient consultation, reorientation to another care pathway, referral to the emergency department, other solutions, no solution, referral back to the attending physician, or teleconsultation.\u003c/p\u003e \u003cp\u003eCalls to entry points 1\u0026ndash;4 (cognitive/behavioral disorders, cardio-geriatrics, onco-geriatrics, pain/palliative care) and 6 (consultation appointment requests) were redirected internally to the corresponding specialty teams at the University Hospital and are not included in this analysis.\u003c/p\u003e \u003cp\u003eAll variables were pre-defined, and categorical outcomes were assigned by the geriatrician handling the call or by the medical secretary in charge of that line.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStudy size\u003c/h2\u003e \u003cp\u003eThe study size included all calls received during the 18-month period (June 2024 \u0026ndash; November 2025). No a priori sample size calculation was performed due to the descriptive nature of the study.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection and analysis\u003c/h3\u003e\n\u003cp\u003eA dedicated traceability system was used to routinely collect data at the time of each call. All calls initiated by community-based general practitioners during the study period were eligible. Calls that were incomplete or duplicated were excluded from the analysis.\u003c/p\u003e \u003cp\u003eAnalyses were purely descriptive and are presented as means with standard deviations for continuous variables and as proportions for categorical variables.\u003c/p\u003e\n\u003ch3\u003eEthics\u003c/h3\u003e\n\u003cp\u003e In accordance with French ethical and regulatory law (Code de la Sant\u0026eacute; Publique), this prospective study based on routine care data did not require formal approval from a national ethics committee but was conducted under the reference methodology MR-004 of the Commission Nationale de l\u0026rsquo;Informatique et des Libert\u0026eacute;s (CNIL). The study protocol was reviewed and authorized by the Ethics Committee of Toulouse University Hospital, which confirmed compliance with national regulations (approval number #RnIPH 2025-76). Toulouse University Hospital declared compliance with CNIL reference methodology MR-004. In accordance with French regulations, patients were informed of the study and of their right to object to the use of their data for research purposes. No opposition was recorded. Therefore, written informed consent was not required under national legislation. The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eCall volume and trends\u003c/h2\u003e \u003cp\u003eDuring the 18 months of operation (June 2024 to November 2025), the hotline received a total of 3,626 calls, corresponding to a monthly average of 201 calls. Activity progressively increased over time, peaking at 425 calls in November 2025, compared with 100 calls during the first month of operation (June 2024; Fig.\u0026nbsp;4).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eCall distribution by thematic category\u003c/h2\u003e \u003cp\u003e Overall call distribution through the hotline\u0026rsquo;s interactive voice response system showed a predominance of requests for general geriatric advice (1,789 calls, 49%), followed by cognitive or behavioral disorders (802 calls, 22%), onco-geriatrics (615 calls, 17%), cardio-geriatrics (255 calls, 7%), palliative care (81 calls, 2%; hotline launched March 2025), and consultation appointment requests (85 calls, 2%; Fig.\u0026nbsp;4).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003ePatient characteristics and call reasons (entry option 5)\u003c/h2\u003e \u003cp\u003eAmong these 1,789 calls, 393 calls were included in the analysis of patient characteristics and call reasons. These calls corresponded to cases where complete data were available, as documentation was dependent on geriatricians or the medical secretary, and not all calls were fully recorded. In addition, multiple calls regarding the same patient were counted only once in the analysis to avoid duplication.\u003c/p\u003e \u003cp\u003eAmong the 393 analyzed calls, the mean patient age was 84.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.62 years, 55.5% were women, and the majority of calls originated from attending physicians (91.9%). The most frequent reasons for calling were impairment of general condition (19.3%), falls (12.5%), neurodegenerative diseases (11.2%), hematology/oncogeriatrics (10.4%), nutrition/metabolic disorders (9.4%), pain (8.1%), social issues (7.9%), and cardiogeriatrics (6.1%). Less frequent reasons (\u0026lt;\u0026thinsp;3%) included gastroenterology, pulmonology, drug-related issues, infectious diseases, dermatology, palliative care, and other conditions (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Calls were placed by approximately 243 unique general practitioners, each counted once regardless of repeated use of the hotline.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003ePatient orientation following the call\u003c/h2\u003e \u003cp\u003eFollowing the call, patient orientation most frequently resulted in hospitalization in an acute geriatric care unit (35.4%), followed by provision of geriatric advice (27.2%), referral to a day hospital (16.0%), reorientation to another care pathway (7.6%), and referral to the emergency department (7.4%). Other outcomes included alternative solutions (2.8%), scheduling of an outpatient consultation (1.8%), no solution identified (0.8%), referral back to the attending physician (0.8%), and teleconsultation (0.3%; Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characteristics (n\u0026thinsp;=\u0026thinsp;393)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWomen (n\u0026nbsp;; %)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e218 (55.5%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e84.25\u0026thinsp;\u0026plusmn;\u0026thinsp;7.62\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReferral source: attending physician (n; %)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e361 (91.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"14\" rowspan=\"15\"\u003e \u003cp\u003eReason for the call (n\u0026thinsp;=\u0026thinsp;393)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eImpairment of the general condition or status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e76 (19.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFalls\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e49 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeurodegenerative diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e44 (11.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHematology / Oncogeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41 (10.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNutrition and metabolic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37 (9.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePain\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (8.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (7.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCardiogeriatrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (6.1%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGastroenterology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13 (3.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePulmonology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDrugs and other advice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfectious diseases\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (2.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDermatology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePalliative care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (0.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"9\" rowspan=\"10\"\u003e \u003cp\u003ePatient orientation following the call (n\u0026thinsp;=\u0026thinsp;393)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHospitalization in an acute geriatric care unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139 (35.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGeriatric advice\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e107 (27.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDay hospital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63 (16.0%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eReorientation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (7.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmergency department\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e29 (7.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOther solutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11 (2.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eScheduling of an outpatient consultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (1.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo solution\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOrientation to the attending physician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTeleconsultation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eOur pilot study demonstrates the feasibility of a territorial geriatric hotline providing rapid access to geriatric expertise for community-based physicians in a population with a growing proportion of older adults. Over 18 months, more than 3,600 calls were recorded, concerning old patients (mean age 84.25 years). Call volume progressively increased over time, reflecting a growing demand from community-based physicians and the successful integration of the hotline into local practice. In more than 90% of cases, an alternative to emergency department transfer was provided, including specialized advice, scheduled hospitalizations, or tailored patient orientation, thereby facilitating more appropriate care pathways and helping to avoid unnecessary emergency department visits. These findings are consistent with previous literature, highlighting that many emergency transfers among older adults could be avoided if geriatric expertise were mobilized in advance.\u003c/p\u003e \u003cp\u003eIn France, a multicenter study conducted across seven hospitals between April 2018 and April 2020, reported that among more than 4,000 calls, 64% were requests for advice and 36% for hospitalization. Nearly half of the hospitalization requests were directed straight to a geriatric unit, thereby avoiding an emergency department transfer (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). Our results align with these findings, with the majority of situations guided toward alternatives to emergency care. The mean age in that study was 86.8 years, slightly higher than in our cohort, likely reflecting a higher proportion of institutionalized patients in hospital-centered experiences. By contrast, our model, based within local professional healthcare networks and involving community-based physicians, likely reached more older adults living at home. Compared this multicenter study (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e), the Toulouse hotline serves a larger population with only two geriatricians, coordinated by 15 local networks of healthcare professionals. In contrast, multicenter study involved several hospital teams with dedicated resources and beds. The Toulouse hotline received an average of 201 calls per month, compared with approximately 25 calls per month per center in the multicenter study, reflecting both the size of the population served and the territorial organization. These findings confirm the feasibility of the hotline while highlighting limitations related to medical workforce density and coverage of a large area. We also believe that co-constructing the intervention with local professional healthcare networks facilitated rapid uptake among general practitioners and accelerated changes in usual practice.\u003c/p\u003e \u003cp\u003eThese initiatives are part of a broader strategy to territorialize healthcare provision and strengthen care coordination, objectives pursued by the 15 local professional healthcare networks in the region, thereby providing older adults with more structured and appropriate access to alternatives to emergency care.\u003c/p\u003e \u003cp\u003eThis dynamic is also rooted in the COVID-19 pandemic, which demonstrated the relevance and feasibility of geriatric hotlines, particularly for nursing home residents. The Toulouse experience, implemented in 2024, builds on these initiatives while adapting the model to local needs. The GTHP program highlighted the benefits of rapid, coordinated access to geriatric expertise and has since been sustained (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e). These initiatives align with broader goals of territorializing healthcare services and strengthening coordination, enabling older adults to access structured alternatives to emergency care.\u003c/p\u003e \u003cp\u003eInternational experiences also support the value of rapid access to geriatric expertise. In the United Kingdom, the \u0026ldquo;Silver Triage\u0026rdquo; model, in which geriatricians provide real-time support to pre-hospital emergency teams, demonstrated that more than 80% of patients were not transported to hospital, with the system considered useful and well accepted by frontline teams (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). In Canada, community paramedicine programs similarly reduced emergency department use among older adults living at home, illustrating the importance of early, specialized intervention (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). However, the implementation of these programs can be demanding in terms of organizational and human resources, as highlighted by the Canadian experience, which required extensive coordination, training, and staffing. While these programs target different patient populations, they illustrate the broader principle that rapid access to geriatric expertise, whether through pre-hospital interventions or territorial hotlines, supports prompt and appropriate patient orientation, facilitates direct admissions to geriatric care when needed, and allows timely specialist advice, ultimately enhancing the quality and coordination of care for older adults.\u003c/p\u003e \u003cp\u003e This study is characterized by its strong territorial context, implemented in coordination with 15 local professional healthcare networks encompassing approximately 290 general practitioners. The hotline was developed through partnerships with both public and private healthcare sectors. A key strength of our study is its scale and representativeness, covering Toulouse, France\u0026rsquo;s fourth largest metropolitan area, with over 3,600 calls recorded during 18 months, reflecting substantial engagement from community-based general practitioners. However, this remains a pilot, monocentric, observational study, and we could not directly measure the hotline\u0026rsquo;s impact on emergency department visits. The availability of geriatricians continues to be a limiting factor for generalization and reproducibility.\u003c/p\u003e \u003cp\u003e Looking ahead, the hotline should be considered as a complementary tool alongside other territorial coordination systems, such as Senior Care Access System (SCAS), to facilitate better patient orientation, optimize care pathways, and ensure that patients receive care in the most appropriate setting. Within the framework of this pilot, physician usage and satisfaction with the hotline are currently being evaluated, as is the geographic distribution of requests. Finally, multicenter and prospective studies will be necessary to assess the actual impact of such interventions on quality of life, iatrogenesis, and emergency department workload. It is also essential that these complementary pathways support patient safety without inadvertently delaying or misdirecting care for vulnerable patients.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis pilot study demonstrates that a territorial geriatric hotline integrated into local professional healthcare networks is feasible and widely utilized, with strong potential to improve patient orientation and provide alternatives to emergency department transfers. Original in its territorial anchoring and in functioning with a limited number of geriatricians, this model illustrates the use of a hotline as a lever to strengthen interprofessional coordination and ensure equitable access to geriatric expertise. It paves the way for new organizational models adapted to demographic transition.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGTHP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeriatric Team Health Care Pathways\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSCAS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSenior Care Access System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":" \u003cp\u003e \u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e \u003cp\u003eIn accordance with French ethical and regulatory law (Code de la Sant\u0026eacute; Publique), this prospective study based on routine care data did not require formal approval from a national ethics committee but was conducted under the reference methodology MR-004 of the Commission Nationale de l\u0026rsquo;Informatique et des Libert\u0026eacute;s (CNIL). The study protocol was reviewed and authorized by the Ethics Committee of Toulouse University Hospital, which confirmed compliance with national regulations (approval number #RnIPH 2025-76). Toulouse University Hospital declared compliance with CNIL reference methodology MR-004. In accordance with French regulations, patients were informed of the study and of their right to object to the use of their data for research purposes. No opposition was recorded. Therefore, written informed consent was not required under national legislation.The study was conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent for publication\u003c/strong\u003e \u003cp\u003eNot applicable.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding\u003c/h2\u003e \u003cp\u003e This work was supported by the Regional Health Agency of Occitanie, France.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003ePeyrusqu\u0026eacute; E: drafted the article, conception, interpretation of data, analysis; Elmalem\u0026nbsp;S: conception, interpretation of data, reviewing the article; Dubucs\u0026nbsp;X: reviewing the article; Roussel\u0026nbsp;M:\u0026nbsp;reviewing the article; Rolland Y: conception, interpretation of data, reviewing the article; Balardy\u0026nbsp;L: conception, interpretation of data, reviewing the article; Villars H: conception, interpretation of data, reviewing the article.\u003c/p\u003e\u003ch2\u003eAcknowledgement\u003c/h2\u003e\u003cp\u003eThe authors would like to thank Mr. Lay Nien Sephan for his involvement in this territorial geriatric hotline, as well as all partners from the local professional healthcare networks and clinics for their valuable support.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePopulation par \u0026acirc;ge\u0026thinsp;\u0026ndash;\u0026thinsp;Tableaux. de l\u0026rsquo;\u0026eacute;conomie fran\u0026ccedil;aise | Insee2020; [cited 2025 Apr 9 ] Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.insee.fr/fr/statistiques/4277619?sommaire=4318291\u003c/span\u003e\u003cspan address=\"https://www.insee.fr/fr/statistiques/4277619?sommaire=4318291\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDavin-Casalena B, Scronias D, Videau Y, Verger P. 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[cited 2025 Apr 9 ] Available from: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://fedoru.fr/wp-content/uploads/2025/03/FEDORU_CC2024_V3.pdf\u003c/span\u003e\u003cspan address=\"https://fedoru.fr/wp-content/uploads/2025/03/FEDORU_CC2024_V3.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRolland Y, Mathieu C, Tavassoli N, et al. Factors Associated with Potentially Inappropriate Transfer to the Emergency Department among Nursing Home Residents. J Am Med Dir Assoc. 2021;22(12):2579\u0026ndash;e25867.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDubucs X, Balen F, Charpentier S, et al. Factors associated with Emergency Medical Dispatcher request and residents\u0026rsquo; inappropriate transfers from Nursing Homes to Emergency Department. Eur Geriatr Med. 2022;13(2):351\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIozzo P, Spina N, Cannizzaro G, et al. Association between Boarding of Frail Individuals in the Emergency Department and Mortality: A Systematic Review. J Clin Med. 2024;13(5):1269.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRoussel M, Teissandier D, Yordanov Y, et al. Overnight Stay in the Emergency Department and Mortality in Older Patients. JAMA Intern Med. 2023;183(12):1378\u0026ndash;85.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMacIsaac M, Peter E. Emergency department crowding: An examination of older adults and vulnerability. Nurs Ethics. 2025;32(1):99\u0026ndash;110.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOliveira JE, Silva L, Berning MJ, Stanich JA, et al. Risk Factors for Delirium in Older Adults in the Emergency Department: A Systematic Review and Meta-Analysis. Ann Emerg Med. 2021;78(4):549\u0026ndash;65.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGoethals L, Barth N, Martinez L, et al. Decreasing hospitalizations through geriatric hotlines: a prospective French multicenter study of people aged 75 and above. BMC Geriatr. 2023;23(1):783.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJones HT, Teranaka W, Hunter P, Gross L, Conroy S. What is the impact of a pre-hospital geriatrician led telephone Silver Triage for older people living with frailty? Eur Geriatr Med. 2023;14(5):977\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAgarwal G, Angeles R, Pirrie M, et al. Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial. Prehosp Emerg Care. 2019;23(5):718\u0026ndash;29.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eINSEE. 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An Innovative Day Hospital Dedicated to Nursing Home Resident: A Descriptive Study of 1306 Residents Referred by their Physicians. J Nutr Health Aging. 2018;22(9):1138\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eVillars H, Balardy L, Ghisolfi A, Blain H, Rolland Y. Geriatric Team Health Care Pathways: An Organizational Innovation to Enhance Care Pathways of Long-Term Care Facilities\u0026rsquo; Residents in the French Region of Occitania. J Am Med Dir Assoc. 2024;25(6):104976.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Older adults, Primary care physicians, Care pathways, Healthcare network","lastPublishedDoi":"10.21203/rs.3.rs-8873768/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8873768/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eFrance is experiencing rapid population aging, increasing demand for healthcare services and pressure on unscheduled care pathways for frail and multimorbid older adults. Many transfers to acute care, including emergency departments, may be avoidable with timely geriatric expertise. In 2024, a territorial geriatric hotline was implemented at Toulouse University Hospital to provide community-based physicians with rapid access to geriatric advice and optimize patient care pathways. The purpose of this study was to describe the development, implementation, and early activity of a territorial geriatric hotline for community-based physicians and assess its feasibility and impact on patient orientation.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eWe conducted a monocentric, observational, descriptive study of the Haute-Garonne territorial geriatric hotline (June 2024\u0026ndash;November 2025). The hotline was developed with 15 local professional healthcare networks and provided rapid access to geriatricians for general practitioners. Only calls requesting general geriatric advice or hospitalization were analyzed; calls related to supra-specialty expertise (onco-geriatrics, cardio-geriatrics, dementia care and palliative care) were redirected internally. Data collected included patient characteristics, reasons for the call, and patient orientation. Analyses were descriptive.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eDuring 18 months, 3,626 calls were received, with monthly activity increasing from 100 to 425 calls. A total of 393 calls with complete data were analyzed (mean age 84.3\u0026thinsp;\u0026plusmn;\u0026thinsp;7.6 years; 55.5% women), placed by 243 general practitioners. Common reasons for calls included impaired general condition (19.3%), falls (12.5%), neurodegenerative diseases (11.2%), hematology/onco-geriatrics (10.4%), nutrition/metabolic disorders (9.4%), and pain (8.1%). Following calls, patient orientation included hospitalization in an acute geriatric unit (35.4%), provision of geriatric advice (27.2%), day hospital admission (16.0%), reorientation to another care pathway (7.6%), and emergency department referral (7.4%).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eA territorial geriatric hotline integrated into local professional healthcare networks is feasible and widely utilized. It facilitates rapid access to geriatric expertise, improves patient orientation, and supports alternatives to emergency department transfers. The model demonstrates how limited geriatric resources can be leveraged to strengthen interprofessional coordination, optimize care pathways, and enhance equity in access to geriatric care. These results provide a basis for further evaluation of its impact on patient outcomes and healthcare system efficiency.\u003c/p\u003e","manuscriptTitle":"Implementation of a Territorial Geriatric Hotline in Southwestern France: A monocentric observational study to improve access to geriatric expertise","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-27 10:15:36","doi":"10.21203/rs.3.rs-8873768/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-03-05T06:57:38+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-05T03:12:53+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-02T19:15:29+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"56558762806941351703182887630322219115","date":"2026-03-02T14:34:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"301550347037833054774670624727496909167","date":"2026-02-27T03:28:57+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37932720089084829956943244488890127584","date":"2026-02-26T14:33:29+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-26T09:27:05+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"317929400715419417218240586899515482354","date":"2026-02-24T12:49:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"94815904347453251773121607541006185226","date":"2026-02-24T07:22:04+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-24T05:17:05+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-23T18:10:02+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-02-20T14:13:39+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-02-20T11:57:39+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2026-02-20T11:52:07+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d2c7b496-56cc-453d-a4ee-4d9648162000","owner":[],"postedDate":"February 27th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-27T05:10:06+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-27 10:15:36","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8873768","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8873768","identity":"rs-8873768","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}