“I’m warning you, I’m deaf as a stone. But at my age, it’s normal. And then, I have no desire to dig the hole of Social Security! » This Monday in December, accompanying his wife Marie-France to a control visit to the Gérontopôle of the Toulouse University Hospital, Maurice, 76, did not expect to go to the developer of the Icope program (Integrated Care for Older People). Designed by the World Health Organization (WHO) and set up by the geriatric center of the Occitan hospital, this screening test for the first signs of frailty in people over 60 can be carried out via a digital application, with or without the assistance of a healthcare professional.
” Do not worryimmediately reassures the caregiver who takes care of the septuagenarian. The examination that we carry out together today is a photograph of your current state of health and the starting point for regular follow-up so that you can remain independent for as long as possible. » To extend the life expectancy in good health of our elders, and thus delay their entry into dependency, the Icope program focuses on six functions of the body deemed essential: mobility, nutrition, vision, hearing , psychic well-being and finally, cognition.
“An installed dependency is no longer reversible”
A battery of questions and tests is planned in order to identify early if a function is altered. Three years ago, Maurice crossed the finish line of a marathon without incident. Suffice to say that he passes with flying colors the test of motricity which consists in getting up from a chair without the support of the hands. However, over the course of the interview, difficulties are raised: «I have a hearing aid, but I can’t stand it. » Then on memory and orientation: “When we get together for Christmas, I will certainly have to ask my wife to remember the names of my grandchildren. »
Frequent memory lapses, impaired vision, unexplained weight loss or depression. These are very often the harbingers of the installation of a vicious circle which precipitates the entry into dependency. “A subject who feels depressed leaves his home less, quickly loses appetite and therefore muscle, which further reduces his mobility”explains Professor Bruno Vellas, coordinator of the Icope program at the Gérontopôle de Toulouse.
This gerontologist sees aging as a staircase: “At the top of it, the elderly person is autonomous. But if we wait for her to go down, we’ll send her straight to the emergency room. Then after a stay in the hospital, she will often join an Ehpad ”. Therefore, according to him, “The slightest step down must be subject to increased vigilance by the healthcare system. An installed dependency is no longer reversible”.
An injunction to “age well”?
The lookouts of the Icope program, those who interpret the alerts highlighted by the questionnaires, are the nurses of the tele-monitoring platform of the Gérontopôle de Toulouse. When an alert goes up via the Icope Monitor application or the Icope Bot conversational robot, they contact users directly to direct them to the Cité de la santé in Toulouse or their attending physician. Their data assessment work is considerable: of the 27,000 participants in the program since its launch in 2020, more than 7,500 have completed it through self-assessment.
The Étienne-Jules-Marey Institute, in Dijon (Côte-d’Or), has developed the Serious Game, which helps maintain the cognitive abilities and mobility of the elderly. / François GUENET/Divergence
Like Icope, other digital innovations promote self-assessment by seniors via free applications on smartphones or tablets. Launched in May 2022 in Hauts-de-France, Tempoforme aims to make its 10,000 users “actors of their aging”. “If they decide to tackle the problem head-on, they can download the Tempoforme report to give to their attending physician who will know what to do. If they decide to shove their issues under the rug, that’s their choice.”considers Professor Éric Boulanger, project leader at the Lille University Hospital.
Except that « lhe propensity to be attentive to the signals sent by his body varies according to social background, the working classes sometimes having a fatalistic conception of their aging.recalls Vincent Caradec, author of Sociology of old age and aging (Ed. Armand Colin). The researcher warns against “an injunction to age well that would make everyone self-employed in their health thanks to the development of a multitude of measurement tools, with the effect of introducing a hyper-responsibility of individuals”.
Irreplaceable human support
By the very admission of practitioners in the sector, the transition from essentially curative medicine to preventive medicine will not be possible without the recruitment of human reinforcements. “Digital applications shed light on the number of older people who need to be taken care of by making them visible. The problem then is to have enough arms to intervene in time and prevent the aggravation of chronic diseases”insists the president of the French Society of Geriatrics and Gerontology (SFGG), Nathalie Salles.
In fact, when dropping out of a function is suspected, more in-depth examinations must be carried out in hospital structures. At the Tempoforme area of the Lille University Hospital, state-of-the-art medical technologies make it possible to carry out a complete assessment: hearing test in noise to detect presbycusis, retinography for age-related macular degeneration (AMD), or still device for measuring bone mineral density. Once the diagnosis has been established, the question of support comes back. “If a user needs physical activity sessions adapted to Cambrai (North, Editor’s note)we have to be able to count on a physiotherapist on site”illustrates Professor Boulanger.
All these initiatives thus come up against the need to weave, throughout the territory, a network of carers which is often lacking. “The possibilities offered by digital technology should never make us lose sight of the need to have physical interlocutors in the field, attentive to the diet and physical activity of seniors. However, family physicians are an endangered species., regrets the sociologist expert on aging, Serge Guérin. Nathalie Salles, she pleads for support for the installation of liberal geriatricians, a specialty in lack of attractiveness.
An encouraging sign in Occitania, 6,000 nurses, physiotherapists, doctors and pharmacists have downloaded the Icope Monitor application. They are valuable mediators for seniors who do not master digital codes. Among them, Pierre-André Raissiguier, pharmacist in Muret (Haute-Garonne), carries out more than thirty consultations per month: “At the counter, you generally have little time to give to your patients… Thanks to the Icope interview, you notice that prescriptions need to be corrected, or even that treatments are taken incorrectly. » Tailor-made which justifies a specific remuneration: 18 € for the first Icope level and 60 € for the second stage of the program, according to the grid established by the Ministry of Health.
More unexpectedly, voluntary postmen were sworn in by Icope at the end of a partnership between La Poste and the Toulouse University Hospital in October 2020. Equipped with a tablet, these postmen criss-cross the territory and serve as a relay for the elderly. crossed on their tour. Close monitoring which demonstrates, according to Serge Guérin, that “digital tools, as interesting as they are to respond to a social demand for home care, are not intended to become the alpha and omega of any policy to support ageing”.
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Preparing for a longevity society
According to INSEE, people over 65 will represent a third of the French population in 2060, i.e. 23.6 million seniors compared to 14.5 million on 1is January 2023. The number of people over 85 will increase from 1.4 million today to more than 5 million in 2060.
This aging of the population will be accompanied by a doubling of the number of dependent elderly people by 2060, bringing the number of beneficiaries of autonomy assistance to 2.3 million, according to projections by the statistical service of the Ministry of health, the DREES.
The evolution of dependency will depend on the progression of disability-free life expectancy, ie the number of years that an individual can expect to live without being limited in their activities. Today, a 65-year-old woman can expect to live more than twelve years without disability and a man almost eleven years, according to data from DREES.
The average age of loss of autonomy is estimated at 83 years.