Strategies for preventing, detecting and monitoring frailty in elderly people living at home

A comprehensive, multidisciplinary and international approach

The aim of the third international seminar on frailty in elderly people organised on 10 June 2011 by MADoPA was to identify practical strategies for preventing, detecting and monitoring frailty in elderly people living at home.

In his introduction, Hervé Michel, Director of MADoPA, gave a reminder of the main characteristics of the notion of frailty and presented the options that had been selected for this seminar:

• A physical approach to frailty, that of Linda Fried, approved scientifically and used in all developed countries. This approach to frailty is based on five relatively simple physical indicators (grip strength, weight, fatigue, walking speed, extent of physical activity), which are separate from incapacity and co-morbidities. It can also be linked with a questionnaire used to measure the areas within which elderly people move around, which is a predictor of frailty.
• A technological alternative used alongside human-based solutions, to identify technology-based systems for preventing, detecting and monitoring frailty in the home environment.

The first part of this seminar explored the opportunities for action opened up by the physical approach to frailty, which allows a distinction to be drawn between pre-frail and frail elderly people. Using the Survey of Health, Aging and Retirement in Europe (SHARE), Professor Brigitte Santos-Eggimann from the Lausanne Institute of Social and Preventive Medicine showed the prevalence of frailty in Europe and in France, and in particular explained that pre-frailty affected between 30 and 50% of elderly people living at home (depending on country and age group). Prevention programmes aimed at pre-frail people had, for example, been introduced in Germany. Professor Ian Cameron from the University of Sydney then presented the results of an intervention programme conducted in Australia among dependent elderly people living at home, illustrating a number of possible means of preventing and treating frailty in elderly people. Lastly, Professor Jacques Duchêne from the University of Technology of Troyes and Régis Guillemaud from CEA Leti reviewed the various technology-based tools used to detect and monitor physical indicators of frailty, as defined by Linda Fried.

Alongside this first series of presentations illustrating means of action based on the physical foundations of frailty, a second series of presentations gave insights into the social aspects of frailty and emerging areas of work. Dr Louise Plouffe from Canada’s Public Health Agency, using a presentation of the World Health Organisation’s Age-friendly Cities programme as her basis, stressed the importance of overall territorial strategies in favour of the elderly and highlighted approaches encouraging social participation. As a sideline to this, Myriam Lewkowicz, Senior Lecturer at the University of Technology of Troyes, presented from an international viewpoint the advantages and limits of various technologies designed to maintain and promote social relations, especially discussion forums and platforms. In a similar vein, she also spoke about the initial findings of a European project on an interactive social television service.

Finally, four experts responded in turn to the issue of the role of technologies in strategies for preventing, detecting and monitoring frailty in elderly people living at home:

• Professor François Béland from the University of Montréal gave an international overview of the various disease prevention and health promotion strategies applicable to frailty.
• Professor Jean-Luc Novella from Reims Teaching Hospital spoke about the demographic challenges in France affecting the health and welfare system and care for elderly people, which call for new and innovative solutions to be found.
• Eugénia Lamas, Head of the Ethics team at France’s National Institute of Health and Medical Research (INSERM) highlighted the ethical issues raised Europe-wide by the use of technology-based solutions in the fields of healthcare and loss of autonomy.
• Robert Picard from the Ministry of Industry spoke about changing economic and industrial trends in France in the development of technology-based solutions for the elderly. He mentioned in particular the emergence of integrative solutions, combining medical and professional rationales with market-driven and user-friendliness considerations, focused on the needs and desires of elderly people.