Needs: are we moving

towards a new health

paradigm ?

Alain FRANCO – franco.a@chu-nice.frProfessor 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