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Ageing – a Global Challenge: Needs: are we moving towards a new health paradigm?. Franco A. eHealth week 2010 (Barcelona: CCIB Convention Centre; 2010)
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Needs: are we moving
towards a new health
paradigm ?
Alain FRANCO – [email protected] of Internal Medicine and Geriatrics (Nice)
President of the ISG
President of the CNRSDA (France)
•Technology & Services• ICT,• Gerontechnology,• Domotics,• Telemedicine,• ISG matrices
Supply
Gerontechnology
matrices
J.E.M.H. van Bronswijk et al.
Gerontechnology 2009;8(1):3-10
Outlook
Age & generation matrixTarget population
1stage
Fo
rma
tive
ye
ars
2nd
age
Ma
in w
ork
ing
ph
ase
3rd
age
Active
re
tire
me
nt
4th
age
Fra
ilty &
De
pe
nd
ence
Tech
no
log
y
gen
era
tio
n
Mechanical products, hierarchical organization
Electro-mechanical products, hierarchical organization
Menu driven products, layered software (‘Microsoft
generation’)
Gaming software with proficiency levels, relational (non-
hierarchical) organization at each level
J.E.M.H. van Bronswijk Gerontechnology 2009;8(1):3-10
Science
Cross-fertilizationTechnology
(Bio
)Ph
ysic
s
(Bio
)ch
em
istr
y
Arc
hite
ctu
re
Build
ing
Info
rma
tio
n
Co
mm
un
ica
tio
n
Me
ch
atr
on
ics
Ro
bo
tics
Erg
on
om
ics
De
sig
n
Bu
sin
ess
ma
na
ge
me
nt
Gero
nto
log
y
Physiology
Nutrition
Psychology
Social psychology
Sociology
Demographics
Medicine
Rehabilitation
J.E.M.H. van Bronswijk Gerontechnology 2009;8(1):3-10
Engineering
Impact on application domainsApplication domain
He
alth
Self-e
ste
em
Ho
usin
g
Da
ily liv
ing
Mo
bili
ty
Tra
nsp
ort
Co
mm
un
ica
tio
n
Go
ve
rna
nce
Wo
rk
Le
isu
re
Main
g
oal
Enrichment
Satisfaction
Prevention
Engagement
Compensation
Substitution
Care support
Care organization
J.E.M.H. van Bronswijk Gerontechnology 2009;8(1):3-10
•Needs• Disability and compensation• Frailty and prevention• Users
Demand
Female longevity is unavoidable, my Dear…!
www.eugms2008.org
Healthy Aging
Baby-boomers becoming « Papy-Boomers »
Nexter older
generation
Children become care givers
Future natural
and professional
care givers
Demographic transition (WHO)
• > 10% of the 65+
• Europe 2000 15%, World’s
number one
• Developed countries in
2020 20%
• Chronic diseases >
acute diseases
Philip Wood’s Sequence
(ICIDH-WHO 1980)
Disease
• Impairment (organ/function)
• Disability (activity/ person)
• Handicap (social life)
Dependency
Philip Wood’s Sequence
(ICIDH-WHO 1980)
Disease
• Impairment (organ/function)
• Disability (activity/ person)
• Handicap (social life)
Dependency
Interactions between the components of the ICF (International Classification of Functioning – WHO 2001)
Health condition (disorder or disease)
Body Functions & Structures
(Impairments)
Activities(Limitations)
Participation(Restrictions)
Personal Factors
Environmental Factors
Interactions between the components of the ICF (International Classification of Functioning – WHO 2001)
Health condition (disorder or disease)
Body Functions & Structures
(Impairments)
Activities(Limitations)
Participation(Restrictions)
Personal Factors
Environmental Factors
Interactions between the components of the ICF (International Classification of Functioning – WHO 2001)
Health condition (disorder or disease)
Body Functions & Structures
(Impairments)
Activities(Limitations)
Participation(Restrictions)
Personal Factors
Environmental Factors
•Functioning &
handicap
Growing and aging
Function
Decompensation threshold
Life
Growing and aging
Function
Decompensation threshold
Life
Growing and aging
Function
Decompensation threshold
Life
1
2
Aging means a decrease in
functioningFunction
Decompensation threshold
Life
Aging means less reserve for
functioningFunction
Decompensation threshold
Life
Reserve
Aging means less reserve for
functioningFunction
Decompensation threshold
Life
Reserve
1
2
Aging means less reserve for
functioningFunction
Decompensation threshold
Life
Frailty threshold
Reserve
Decompensation treshold
Functioning
Life
Handicap Situation
Functioning
Decompensation treshold
Life
Decompensation -
CompensationFunctioning
Decompensation treshold
Life
Prevention
Functioning
Decompensation treshold
Life
Prevention
Functioning
Decompensation treshold
Life
Compensation
Functioning
Decompensation treshold
Life
Needs
Functioning
Decompensation treshold
Life
Housing
Mobility solut.
Accessibility
Inf.Technology
Drugs
Care
Employement
Education
Fun Leisure
Needs
Functioning
Decompensation treshold
LifePrevention !...
Housing
Mobility solut.
Accessibility
Inf.Technology
Drugs
Care
Employement
Education
Fun Leisure
Housing
Mobility solut.
Accessibility
Inf.Technology
Drugs
Care
Employement
Education
Fun Leisure
Needs
Functioning
Decompensation treshold
LifePrevention !...
Housing
Mobility solut.
Accessibility
Inf.Technology
Drugs
Care
Employement
Education
Fun Leisure
Housing
Mobility solut.
Accessibility
Inf.Technology
Drugs
Care
Employement
Education
Fun Leisure
Rights
Functioning
Decompensation treshold
LifePrevention !...
Housing
Mobility solut.
Accessibility
Inf.Technology
Drugs
Care
Employement
Education
Fun Leisure
Housing
Mobility solut.
Accessibility
Inf.Technology
Drugs
Care
Employement
Education
Fun Leisure
Expression of the needs by
• The disease• Diagnostic, Treatment
• Monopathology
• Patients’ group or association or lobby
• The consequences of the disease(s)• Pain, palliative care
• Polypathology (ageing)
• Disability, handicap
Expression of the needs by
• The disease• Diagnostic, Treatment
• Monopathology
• Patients’ group or association or lobby
• The consequences of the disease(s)• Pain, palliative care
• Polypathology (ageing)
• Disability, handicap
Expression of the needs by
• The disease• Diagnostic, Treatment
• Monopathology
• Patients’ group or association or lobby
• The consequences of the disease(s)• Pain, palliative care
• Polypathology (ageing)
• Disability, handicap
Disease & Case management
Disease management
Monopathology
Young & Adult
Health issues
Drugs
Groups
Disease & Case management
Disease management Case management
Monopathology
Young & Adult
Health issues
Drugs
Groups
Polypathology
Comorbidity
Frailty
Disability
Older person
Functioning
Social issues
Care
Individual
Thus, from the WHO
• ICD (10) fits with the traditional medical model,
the disease-treatment model
• ICF (1) fits with the new functioning model
Unifying conceptual model that shared risk factors
may lead to geriatric syndromes, then to frailty, with
feedback mechanisms. Poor outcomes.
J Am Geriatr Soc 55:780–791, 2007.
Towards a new health paradigm
• Moving from the hippocratic classical paradigm:
• acute disease, diagnostic, treatment, hospital, prim.
prevention, medical power, pharmacy
• To a new functional paradigm:
• case issues, personal functioning, chronical
diseases, handicap, compensation, sec or tert.
prevention, home care, shared power, technology
Needs for older people
• Environmental needs: housing, mobility,
nutrition, inclusion,…
Community, family, personal means, professionals,
regions, EU,…
good practices, quality of care
• Human rights needs: security, equity in
accessibility, no discrimination, minimal income,
health & aid,…
State guaranty, European initiative, International
Convention under United Nations auspices, ….
Conclusions
1. Technology is an example of domain
addressing needs in a new functioning
paradigm
2. Technology takes place beside biology and
human sciences as a major field of research in
geriatrics and gerontology
3. Gerontechnology concerns aging or elderly
user, either healthy, frail or diseased.
Conclusions
4. Gerontechnology implies a common language between health professionals, methodologists, psycho-sociologists, technologists and a method to work together commonly practiced in gerontologic activities
5. In the future technology should efficiently contribute to prevention, assist aging physically and/or mentally handicapped persons, and contribute to reduce the burden of caregivers.
Take Home Messages
• Technologies & services face multiple needs
• There is a lack of caregivers in a close future
• Should the market for healthy aging be the
same or different from the market for diseased
and frail persons ?
• Who will pay in the routine ?
• Needs for a clinical gerontechnology ?
Thèmes:
• Méditerranée
• Gérontechnologie
• Thérapeutique
