APPAPA

The APPAPA research project proposes to study the deployment of schemes including PA programs for elderly people, identified as "pre-fragile", "frail" or "dependent", in order to fight against their loss of autonomy. It analyzes their contribution to public health policies and seeks to understand the tensions and obstacles that accompany their deployment. The study involves ten survey sites corresponding to the geographical areas covered by the consortium, itself designed to cover a variety of territories (with different demographic and socio-economic profiles), favoring an intra-territorial, inter-territorial and inter-site comparative perspective. The theoretical approach combines social geography and public action with a sociology of regimes of action and justifications, sensitive to the normative repertoires of systems and the forms of adjustment between heterogeneous players. The interactionist and socio-ecological approaches used are conducive to the study of user participation. The investigation is based on three problematic axes that accompany the research approach, based on three levels of scale that are nested and interconnected according to the principle of "linked ecologies". The first axis (WPA) consists in mapping the measures in place to prevent the effects of ageing through physical activity in each of the areas investigated. A territorial typology will be drawn up, listing facilities that include PA programs for pre-fragile, frail or even dependent elderly people. The study covers four main areas of investigation: 1/ gerontopoles, hospitals, clinics - 2/ local authorities - 3/ multi-disciplinary health or sport-health centers - 4/ ESMS, EHPAD, EHPA and senior residences. The aim is to make the structuring of public action in this field, the main players involved, the resources and targets involved, as well as the social, economic, geographical and cultural context of the schemes listed, all more legible and comparable. In this sense, the WPA reveals any territorial inequalities. The second axis (WPB) of the study involves an in-depth monographic analysis of several schemes including PA programs, selected for their archetypal character. The aim is to objectivize the action regimes accompanying their deployment, by examining their organizational framework, the resources available, the knowledge mobilized (normative repertoires, representations of fragility, preferred modes of intervention, etc.), and the forms of collaboration between players. The aim of this analysis is to gain a better understanding of the multiple areas of expertise involved in this field of non-medication health care, which is marked by competition, knowledge and power issues reflecting asymmetries between the players involved and revealing coordination difficulties. The third axis (WPC) focuses on the place given to the elderly in the proposed programs. It questions the reality of a participatory or inclusive approach, as desired by health authorities. To do so, it crosses the study of the PA offer according to the operators involved with the analysis of its reception by the public concerned and their close caregivers. The aim is to identify the uses of the PA systems and programs studied, paying close attention to the social representations of ageing, the frailty criteria used, and how biopsychosocial and environmental factors are taken into account in the preferred intervention strategies. This makes it possible to observe the reality of the active and conscious involvement of older people, considering in particular the importance of epistemic injustices/inequalities, which can activate forms of ageism in this health sector.