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

Etienne Minvielle
Etienne Minvielle
CNRS Research Director and Professor of Health Management at Ecole Polytechnique (IP Paris)
Yves Rolland
Yves Rolland
Professor of Internal Medicine and Geriatrics at the Gerontopôle of Toulouse
Olivier Guérin
Olivier Guerin
Professor at the Université Côte d'Azur and member of the President of the Republic's scientific council
Key takeaways
  • Since the 1960s, human life expectancy has increased rapidly, but the years gained do not always go hand in hand with a “good quality of life”.
  • At the same time as this demographic transition, climate change will have an impact on the human population, which will become more fragile with age.
  • “Good health” is defined by the maintenance of functional capacities, i.e. a suitable living environment combined with good intrinsic capacities.
  • Digital programmes such as ICOPE aim to prevent dependency among the elderly and ensure that they enjoy a good quality of life.
  • These digital medical tools provide a personalised, patient-centred care pathway.

Life expectan­cy is increas­ing rapid­ly. Between the 1960s and the begin­ning of the 21st 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.

Digital medicine: an innovative program

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.

From managing dependency to preventing it

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. 

From obser­va­tion to innovation

It was in the 1980s that Dr Lau­rence Z. Ruben­stein was the dri­ving force behind this idea. See­ing his patients seek­ing fur­ther con­sul­ta­tions short­ly after being treat­ed, he sus­pect­ed a flaw in the health­care sys­tem. In 1984, he pub­lished the promis­ing results of his study in the New Eng­land Jour­nal of Med­i­cine. The imple­men­ta­tion of a glob­al assess­ment of his patients, what­ev­er the pathol­o­gy that brought them in, made it pos­si­ble to pre­vent their func­tion­al decline and pre­serve their auton­o­my. This project (car­ried out on a sam­ple of 200 elder­ly peo­ple) was con­firmed 10 years lat­er by an ini­tial meta-analy­sis. Grad­u­al­ly, there was a col­lec­tive real­i­sa­tion that our health­care sys­tem was not adapt­ed to the needs of the elder­ly, who required com­pre­hen­sive, indi­vid­u­alised care.

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.

The simultaneous threat of two major transitions

“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

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