Algorithms, a major tool in the quest for “ageing well”

Life expect­ancy is increas­ing rap­idly. Between the 1960s and the begin­ning of the 21^st Cen­tury, the aver­age lifespan has increased by around 20 years. How­ever, these extra years do not always mean a “good qual­ity of life”. Even though “ger­os­cience” and med­ic­al pro­gress are mak­ing it easi­er to under­stand the signs of age­ing, the chal­lenge today is to “age well”. To achieve this, the use of digit­al tech­no­logy is a real oppor­tun­ity. Algorithms, already used to pre­vent the onset of can­cer or to pre­dict epi­dem­ic risks, can now help anti­cip­ate depend­ency and age-related pathologies.

The ICOPE (Integ­rated Care for Older People) digit­al pro­gramme, devised by the WHO, has been in use in France since 2019. For the first time, an exper­i­ment­al sys­tem is test­ing a new pre­vent­ive approach, tar­get­ing the intrins­ic capa­city of patients over the age of 60. By self-assess­ment, or accom­pan­ied by a pro­fes­sion­al or non-pro­fes­sion­al carer, simple tests are used to assess six essen­tial areas in the quest for a good qual­ity of life:

• Mobil­ity
• Nutri­tion­al status
• Men­tal health
• Cog­ni­tion
• Hear­ing
• Vis­ion

If any of these areas are found to be lim­ited, the trained med­ic­al staff will carry out a more detailed clin­ic­al assess­ment and, if neces­sary, draw up a per­son­al­ised long-term care plan. The care offered is var­ied (social sup­port, home adapt­a­tions, physio­ther­apy, thera­peut­ic adapt­a­tions, etc.) and depends on the pathology.

ICOPE, which ori­gin­ated in the Occit­an­ie region of France, is now being rolled out nation­wide. Today, 42,000 seni­or cit­izens are test­ing the pro­gramme, which will even­tu­ally enable bench­mark stand­ards to be set for age-related patho­lo­gies. The pro­gramme is avail­able in the form of an applic­a­tion (ICOPE MONITOR) and a con­ver­sa­tion­al robot (ICOPE BOT). Thanks to this, autonom­ous eld­erly people liv­ing at home are act­ively involved in strength­en­ing or pre­serving their intrins­ic capa­cit­ies. At the same time, almost 10,000 health­care pro­fes­sion­als have been trained to respond to alerts.

With this sys­tem being deployed over the last five years, the WHO is chan­ging the defin­i­tion of good health. Being in good health means above all main­tain­ing good func­tion­al capa­city. This is the res­ult of a suit­able liv­ing envir­on­ment com­bined with intrins­ic capa­cit­ies, i.e. the main­ten­ance of sens­ory, psy­cho­lo­gic­al, nutri­tion­al, motor and cog­nit­ive abil­it­ies. Accord­ing to geri­at­ric experts, these para­met­ers have a major influ­ence on healthy age­ing. Pre­serving them delays the onset of depend­ency and there­fore helps main­tain a good qual­ity of life.

ICOPE is an adapt­ive pro­gramme. It con­tin­ues to be adjus­ted and deployed accord­ing to the­or­et­ic­al and prac­tic­al obser­va­tions. So far, this pro­gramme has proved that digit­al medi­cine can identi­fy the determ­in­ants of frailty at an early stage, enabling early inter­ven­tion with an integ­rated, per­son­al­ised care pathway.

Com­pared with oth­er forms of medi­cine, geri­at­ric medi­cine has its own unique approach. While we usu­ally look for a single patho­logy, in the field of geri­at­rics a vari­ety of symp­toms often arise from mul­tiple factors asso­ci­ated with age (isol­a­tion, depres­sion, mal­nu­tri­tion, etc.). The aim of this innov­at­ive digit­al tool is to put the patient back at the heart of the care path­way. We are no longer just treat­ing ill­nesses, but the patient as a whole. 

Around 10% of seni­ors lose their inde­pend­ence dur­ing hos­pit­al­isa­tion. To ensure a qual­ity end to life, treat­ing ill­ness is not enough. By integ­rat­ing digit­al medi­cine into care path­ways (via sys­tems such as ICOPE), the WHO has a num­ber of object­ives: to reduce the num­ber and cost of hos­pit­al admis­sions, delay admis­sions to retire­ment homes and pre­vent func­tion­al decline.

“We need to take a more glob­al approach to the issue of the eld­erly”, says Yves Rolland. The world’s pop­u­la­tion is age­ing rap­idly. Accord­ing to the WHO, the num­ber of people aged 80 or over is set to triple by 2050. This demo­graph­ic trans­ition prom­ises to dra­mat­ic­ally change the world on numer­ous levels, start­ing with the health­care sec­tor. At the same time as the needs of an age­ing pop­u­la­tion increase, the num­ber of carers prom­ises to fall sharply over the next twenty years or so. Added to this is an envir­on­ment­al threat. Cli­mate change, which is already well under­way, will have a major impact on a human pop­u­la­tion weakened by age.

This com­bin­a­tion of threats makes pre­vent­ive health­care vital. It is cru­cial to reor­gan­ise the health­care sys­tem, make it more access­ible and step up our efforts in pre­vent­ive com­mu­nic­a­tion. These efforts should not be con­fined to the hos­pit­al sec­tor but should extend to the more “aca­dem­ic” dis­cip­lines. We’re talk­ing about “health-bio-clin­ic­al-social-envir­on­ment­al” pre­ven­tion. To put it plainly, ensur­ing “age­ing well” requires main­tain­ing health and inde­pend­ence through a vari­ety of dis­cip­lines: med­it­a­tion, sport, diet, psy­cho­logy, etc. The aim is to reach a wide range of people, espe­cially those fur­thest from the health­care system.

Loraine Odot