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