Needs: are we moving
towards a new health
    paradigm ?
Alain FRANCO – franco.a@chu-nice.fr
  Professor of Internal Medic...
Supply
• Technology & Services
 •   ICT,
 •   Gerontechnology,
 •   Domotics,
 •   Telemedicine,
 •   ISG matrices
Gerontechnology
matrices
J.E.M.H. van Bronswijk et al.
Gerontechnology 2009;8(1):3-10
Outlook
  Age & generation matrix                                                                   Target population




...
Science
  Cross-fertilization
                                                                     Technology




        ...
Engineering
       Impact on application domains
                                                             Application ...
Demand
• Needs
 • Disability and compensation
 • Frailty and prevention
 • Users
Female longevity is unavoidable, my Dear…!
Healthy Aging




  www.eugms2008.org
Nexter older
generation




Baby-boomers becoming « Papy-Boomers »
Future natural
and professional
  care givers




          Children become care givers
Demographic transition (WHO)

• > 10% of the 65+
  •   Europe 2000 15%, World’s
      number one
  •   Developed countries...
Philip Wood’s Sequence
(ICIDH-WHO 1980)

              Disease
 • Impairment (organ/function)
 • Disability (activity/ per...
Philip Wood’s Sequence
(ICIDH-WHO 1980)

              Disease
 • Impairment (organ/function)
 • Disability (activity/ per...
Interactions between the components of the
ICF (International Classification of Functioning – WHO 2001)


                ...
Interactions between the components of the
ICF (International Classification of Functioning – WHO 2001)


                ...
Interactions between the components of the
ICF (International Classification of Functioning – WHO 2001)


                ...
•Functioning &
 handicap
Growing and aging
 Function




                    Decompensation threshold


                               Life
Growing and aging
 Function




                    Decompensation threshold


                               Life
Growing and aging
 Function
               1

                    2




                        Decompensation threshold

...
Aging means a decrease in
functioning
  Function




                     Decompensation threshold


                     ...
Aging means less reserve for
functioning
 Function




                 Reserve


                      Decompensation thr...
Aging means less reserve for
functioning
 Function


                 1
                 2

                 Reserve

    ...
Aging means less reserve for
functioning
 Function




                 Reserve

                      Frailty threshold

...
Functioning




              Decompensation treshold


                         Life
Handicap Situation
 Functioning




                     Decompensation treshold


                                Life
Decompensation -
Compensation
 Functioning




                   Decompensation treshold


                              ...
Prevention
 Functioning




               Decompensation treshold


                          Life
Prevention
 Functioning




               Decompensation treshold


                          Life
Compensation
Functioning




                 Decompensation treshold


                            Life
Needs
                   Housing
               Mobility solut.
 Functioning    Accessibility
               Inf.Technolog...
Needs
                       Housing
                   Mobility solut.
 Functioning
   Housing          Accessibility
 Mo...
Needs
                       Housing
                   Mobility solut.
 Functioning
   Housing          Accessibility
 Mo...
Rights
                       Housing
                   Mobility solut.
 Functioning
   Housing          Accessibility
 M...
Expression of the needs by

• The disease
  • Diagnostic, Treatment
  • Monopathology
  • Patients’ group or association o...
Expression of the needs by

• The disease
  • Diagnostic, Treatment
  • Monopathology
  • Patients’ group or association o...
Expression of the needs by

• The disease
  • Diagnostic, Treatment
  • Monopathology
  • Patients’ group or association o...
Disease & Case management



  Disease management


  Monopathology
  Young & Adult
  Health issues
  Drugs
  Groups
Disease & Case management



  Disease management   Case management
                         Polypathology
               ...
Thus, from the WHO

• ICD (10) fits with the traditional medical model,
  the disease-treatment model
• ICF (1) fits with ...
Unifying conceptual model that shared risk factors
 may lead to geriatric syndromes, then to frailty, with
 feedback mecha...
Towards a new health paradigm

• Moving from the hippocratic classical paradigm:
  • acute disease, diagnostic, treatment,...
Needs for older people

• Environmental needs: housing, mobility,
  nutrition, inclusion,…
   Community, family, personal...
Conclusions

1. Technology is an example of domain
   addressing needs in a new functioning
   paradigm
2. Technology take...
Conclusions

4. Gerontechnology implies a common language
   between health professionals, methodologists,
   psycho-socio...
Take Home Messages

• Technologies & services face multiple needs
• There is a lack of caregivers in a close future
• Shou...
Thèmes:
• Méditerranée
• Gérontechnologie
• Thérapeutique
Ageing – a Global Challenge: Needs: are we moving towards a new health paradigm?
Ageing – a Global Challenge: Needs: are we moving towards a new health paradigm?
Ageing – a Global Challenge: Needs: are we moving towards a new health paradigm?
Ageing – a Global Challenge: Needs: are we moving towards a new health paradigm?
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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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Ageing – a Global Challenge: Needs: are we moving towards a new health paradigm?

  1. 1. Needs: are we moving towards a new health paradigm ? Alain FRANCO – franco.a@chu-nice.fr Professor of Internal Medicine and Geriatrics (Nice) President of the ISG President of the CNRSDA (France)
  2. 2. Supply • Technology & Services • ICT, • Gerontechnology, • Domotics, • Telemedicine, • ISG matrices
  3. 3. Gerontechnology matrices J.E.M.H. van Bronswijk et al. Gerontechnology 2009;8(1):3-10
  4. 4. Outlook Age & generation matrix Target population Frailty & Dependence Main working phase Active retirement Formative years 2nd age 3rd age 4th age 1st age Mechanical products, hierarchical organization Technology generation 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
  5. 5. Science Cross-fertilization Technology Communication (Bio)chemistry Mechatronics management (Bio)Physics Architecture Ergonomics Information Business Robotics Building Design Physiology Nutrition Gerontology Psychology Social psychology Sociology Demographics Medicine Rehabilitation J.E.M.H. van Bronswijk Gerontechnology 2009;8(1):3-10
  6. 6. Engineering Impact on application domains Application domain Communication Governance Self-esteem Daily living Transport Housing Mobility Leisure Health Work Enrichment Satisfaction Main goal Prevention Engagement Compensation Substitution Care support Care organization J.E.M.H. van Bronswijk Gerontechnology 2009;8(1):3-10
  7. 7. Demand • Needs • Disability and compensation • Frailty and prevention • Users
  8. 8. Female longevity is unavoidable, my Dear…!
  9. 9. Healthy Aging www.eugms2008.org
  10. 10. Nexter older generation Baby-boomers becoming « Papy-Boomers »
  11. 11. Future natural and professional care givers Children become care givers
  12. 12. Demographic transition (WHO) • > 10% of the 65+ • Europe 2000 15%, World’s number one • Developed countries in 2020 20% • Chronic diseases > acute diseases
  13. 13. Philip Wood’s Sequence (ICIDH-WHO 1980) Disease • Impairment (organ/function) • Disability (activity/ person) • Handicap (social life) Dependency
  14. 14. Philip Wood’s Sequence (ICIDH-WHO 1980) Disease • Impairment (organ/function) • Disability (activity/ person) • Handicap (social life) Dependency
  15. 15. Interactions between the components of the ICF (International Classification of Functioning – WHO 2001) Health condition (disorder or disease) Body Functions & Structures Activities Participation (Limitations) (Restrictions) (Impairments) Environmental Personal Factors Factors
  16. 16. Interactions between the components of the ICF (International Classification of Functioning – WHO 2001) Health condition (disorder or disease) Body Functions & Structures Activities Participation (Limitations) (Restrictions) (Impairments) Environmental Personal Factors Factors
  17. 17. Interactions between the components of the ICF (International Classification of Functioning – WHO 2001) Health condition (disorder or disease) Body Functions & Structures Activities Participation (Limitations) (Restrictions) (Impairments) Environmental Personal Factors Factors
  18. 18. •Functioning & handicap
  19. 19. Growing and aging Function Decompensation threshold Life
  20. 20. Growing and aging Function Decompensation threshold Life
  21. 21. Growing and aging Function 1 2 Decompensation threshold Life
  22. 22. Aging means a decrease in functioning Function Decompensation threshold Life
  23. 23. Aging means less reserve for functioning Function Reserve Decompensation threshold Life
  24. 24. Aging means less reserve for functioning Function 1 2 Reserve Decompensation threshold Life
  25. 25. Aging means less reserve for functioning Function Reserve Frailty threshold Decompensation threshold Life
  26. 26. Functioning Decompensation treshold Life
  27. 27. Handicap Situation Functioning Decompensation treshold Life
  28. 28. Decompensation - Compensation Functioning Decompensation treshold Life
  29. 29. Prevention Functioning Decompensation treshold Life
  30. 30. Prevention Functioning Decompensation treshold Life
  31. 31. Compensation Functioning Decompensation treshold Life
  32. 32. Needs Housing Mobility solut. Functioning Accessibility Inf.Technology Drugs Care Employement Education Fun Leisure Decompensation treshold Life
  33. 33. Needs Housing Mobility solut. Functioning Housing Accessibility Mobility solut. Inf.Technology Accessibility Drugs Inf.Technology Care Drugs Employement Care Education Employement Fun Leisure Education Fun Leisure Decompensation treshold Prevention !... Life
  34. 34. Needs Housing Mobility solut. Functioning Housing Accessibility Mobility solut. Inf.Technology Accessibility Drugs Inf.Technology Care Drugs Employement Care Education Employement Fun Leisure Education Fun Leisure Decompensation treshold Prevention !... Life
  35. 35. Rights Housing Mobility solut. Functioning Housing Accessibility Mobility solut. Inf.Technology Accessibility Drugs Inf.Technology Care Drugs Employement Care Education Employement Fun Leisure Education Fun Leisure Decompensation treshold Prevention !... Life
  36. 36. 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
  37. 37. 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
  38. 38. 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
  39. 39. Disease & Case management Disease management Monopathology Young & Adult Health issues Drugs Groups
  40. 40. Disease & Case management Disease management Case management Polypathology Comorbidity Monopathology Frailty Young & Adult Disability Health issues Older person Drugs Functioning Social issues Groups Care Individual
  41. 41. Thus, from the WHO • ICD (10) fits with the traditional medical model, the disease-treatment model • ICF (1) fits with the new functioning model
  42. 42. 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.
  43. 43. 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
  44. 44. 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, ….
  45. 45. 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.
  46. 46. 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.
  47. 47. 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 ?
  48. 48. Thèmes: • Méditerranée • Gérontechnologie • Thérapeutique

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