Yes, your surroundings help you age well

By 2061, 25% of Quebecers will be 85 years of age or older.

With more and more seniors, there is a need to mobilize in greater numbers to give them the best quality of life. However, this goes beyond the health sector and families : it is the whole community that is concerned.

For example, to ensure that people stay at home as long as possible — as they often want it — municipalities, territorial organizations, the community sector, public institutions must respond to the call.

“The glass ceiling is often motivational. We need to decompartmentalize health and well-being, care with the living environment and the community, to integrate all of this into a one-stop shop, so that the elderly can find their way around more easily”, summarizes the professor at Lyon Est Faculty of Medicine and French hospital practitioner, Pierre Krolak-Salmon. He spoke during the panel “ Health, well-being, aging : a challenge of decompartmentalization ” of Entretiens Jacques-Cartier, which brings together researchers from France and Quebec every two years.

This mutual aid can go through municipalities offering opportunities for seniors to be more active — see this text — or accessible leisure, such as free theater tickets. Or take the form of packed lunches to support their dietary needs.

Since 2017, the World Health Organization (WHO) has developed the ICOPE program – Integrated Care for Older People  or “Integrated Care of the Elderly” — intended to guide the community. This program aims to detect the loss of capacity of people (cognitive decline, limited mobility, visual impairment, hearing loss and depressive symptoms), but also to assess the needs in terms of health, food and care. , in order to develop a personalized plan.

“Seniors are the actors of their health. They don't want to be a burden. They need to feel useful and to be part of society,” recalls the researcher who set up such a program to identify frailty in the population with general practitioners in Greater Lyon. ICOPE is currently being tested in the Toulouse region, in collaboration with La Poste (see box), and could be extended to the whole of France.

At home and active in Quebec

In Quebec too, the number of seniors is increasing and, with it, a need to listen to seniors and respect the choice of many to stay at home as long as possible. The shift has begun to be felt, as evidenced by the living environment initiatives and intergenerational activities, but also the increase in the number of age-friendly municipalities.

In 2011, one out of eight Quebecers (12%) was aged 85 and over, and this will be nearly 25% in 2061. However, people aged 70, 80 and 90 do not need the same care and services. . “ Approaches must be nuanced to adapt them to different age groups ”, agrees the co-director of the Quebec Network for Research on Aging, Pierrette Gaudreau.

To illustrate this healthy and active aging at home, put forward by the Quebec Ministry of Health with its policy “ Aging and living together, at home in your community ”, Ms Gaudreau presents the artist-painter Armand Vaillancourt , 96 years old. “ Always alert and full of projects, that's what to aim for. »

This is what the research carried out by this network with different cohorts shows. Older people are increasingly taking part in research, because they “know what they need to live well and in good health, such as a supportive environment or good financial health”, notes Pierrette Gaudreau, who is also vice -academic dean — fundamental sciences at the Faculty of Medicine of the University of Montreal.

She gives the example of memory problems. “A very often reported concern: they worry about losing their memory, more than about falling or losing weight. »

For a healthy brain

This concern of the elderly finds resonance in the work of the holder of the Canada Research Chair in Cognitive Neuroscience of Aging and Brain Plasticity at the University of Montreal, Sylvie Belleville.

Often, memory problems are less supported by the health community, while it is a concern, particularly for older women. “ Helping seniors maintain a good cognitive reserve and trying to postpone the diagnosis of Alzheimer's or dementia is a win-win situation and it has an impact on the individual and society ”, argues the researcher.

She recalls that most of the risk factors associated with dementia (smoking, depression, isolation, lack of physical activity, etc.) are modifiable in nearly 40% of cases.

The one who is also director of the Quebec Consortium for the early identification of Alzheimer's disease (CIMA-Q) and of the “Brain Health Program” for the Canadian Consortium on Neurodegeneration in Aging, believes that working on plasticity of the brain functions even at an advanced age. In this sense, she develops various interventions intended to support the cognitive health of seniors.

Technology could have a big impact, she says. More than 70% of seniors say they are comfortable with technology: 50% have made health appointments online during the pandemic, and 83% even go online every day, according to a 2020 survey. “ The pandemic has shown us that digital technology is present in the lives of seniors and that by obtaining information and having fun online, they maintain or improve their cognitive abilities”, assures Sylvie Belleville.< /p>

This “ cognitive reserve ” would in turn contribute to protecting the brain — this would allow them to preserve good cognitive abilities despite neuronal changes related to age, or Alzheimer's.

Detect weaknesses

Still, it is not easy to identify vulnerabilities before illnesses and falls occur. We must also take into account the social, economic and political context in which seniors live.

“What will work well in Lyon might not work well in Montreal. It is important to fully understand the role of the stakeholders and their commitment, without forgetting the facilitating elements (skills, training, etc.) and the barriers (distance, other language, etc.)”, notes Lise Gauvin, full professor at the 'School of Public Health of the University of Montreal — EPSUM.

The researcher gives the example of community-based intervention on activity limitations, REACT — for Retirement in ACTION. This physical activity and lifestyle maintenance program aimed to support people living with reduced limbs, with the aim of preventing the decline of functions and abilities in these seniors.

And two years later, of the 777 participants recruited from 35 frontline health centers — mean age 77.6 and two-thirds female — the majority were still seeing the benefits of this physical support program.

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“ Fidelity to the program, however, depended on the way it was implemented, the person's pleasure in doing it and the social support they received,” she adds.

It is sometimes important to “step aside” in order to also consider care and assistance practices for the elderly, in order to be able to improve them and adapt them to the people who receive them. At least that is what the professor of social psychology of health at the University Lumière Lyon 2 (France), Marie Préau recommends.

The French researcher also highlights the many socio-economic inequalities experienced by the elderly, starting with the digital divide. Seniors are not all comfortable with new technologies and society's shift towards “all-digital” (payment of bills, consultation of medical records, etc.) is taking place somewhat in spite of the less well-off and the less familiar with technologies.

She was interested in the negative representations that are even found among some professionals in the care network, as some studies report. She also points out that the perception we have of aging influences geriatric care. “Practices depend on social norms and beliefs, for example the tenacious dogma of 'aging well' and robustness, seen as individual capital. There are also ambivalent representations of the elderly, close to ageism and carrying discrimination,” she notes.

Hence the importance of grouping together and seeking avenues of action in a multidisciplinary way, outside of care, she insists. “ We must aim for a “health democracy” by involving everyone, even professionals and researchers outside the medical sphere ”.

This would make it possible to weave community health close to where people live. . “ Why not go further and challenge architects or designers, to intervene on the buildings and the environment of our elders ”, adds Marie-Pascale Pomey, doctor and professor of public health at ESPUM, and the one of the co-organizers of this symposium at the Entretiens Jacques-Cartier.

What a geriatric care team can do is limited to the medical problems of the person. While the community can act preventively; the quality of life and well-being of today's and tomorrow's seniors depends on it.

Door-to-door for seniors

Would you ask the postman about your mother? The ICOPE project, an initiative of the French Post Office inspired by the WHO's ICOPE program, aims to reach out to the elderly to get news about their health.

Set up on an exploratory basis in the region of Toulouse, in the south-west of France, in partnership with the university hospital center of this city, it is a question of identifying isolated elderly people and evaluating them by means of a questionnaire submitted by the postmen, the first agents of this health screening.

Unlike in Quebec where the shift is towards post office boxes, the French postmen still carry the mail from door to door. “ This measure is more effective among people aged 70 and over – the experiment was conducted with 1,130 people aged 60 and 70 – and encourages us to reflect on our contribution to looking after “seniors” and how we can 'enroll in the city-hospital geriatric sector , explains Omar Beloncif, the medical director of Le Groupe La Poste.