Publish at May 31 2022 Updated June 07 2022
It's been said! The World Health Organization (WHO) informs us that we are old from the age of 60! For the thesis, it is 65 years old, which is the Belgian legal age at the date of cessation of activity. On a global level, old age covers very different situations.
Even at the level of a country, the situation of people advancing in age can vary greatly. The gait of people we can pass in the street, their complexion, already give us quite a lot of information about the great diversity of situations.
The French writer Edouard Louis tells in his books about the broken bodies of his father and the workers: we know that living conditions and environmental factors significantly modify the structure and functions of the body.
With similar genetic factors, no two people will have the same vitality depending on how they have lived, worked, eaten, loved.
The author of the thesis, Patrick Maggi, brings back, for these age-related vitality issues, the concepts of frailty and robustness.
WHO defines frailty as:
"A progressive age-related regression of physiological systems that results in a decrease in intrinsic capacity reserves, conferring extreme vulnerability to stressors and increasing the risk of a range of negative health outcomes. "
Thus, when more than two deficits are noted, the person is in a state of frailty: weight loss, weakness, fatigue, slowness of walking, and low level of physical activity (sedentary lifestyle). The pre-fragile (!) age starts at 50 years old. If there are no deficits or only one deficit is noted, the person is in a robust state.
Let's be reassured, and I can attest to this, it is reversible. But it's not continuously reversible, and we have to come to terms, for ourselves and our loved ones, with the effects of age.
We may have already been faced with decisions to make, and the discourse of the knowers sometimes has trap words, of those words in everyday language that mean something else in a medical context. Fragility. Robustness. Dementia. Capacity.
Who would imagine that there are criteria for frailty and that the number of boxes checked determines discharge from the revalidation center (the operation that follows hospitalization in Belgium, also called follow-up care in France).
The research includes an analysis of medical practices related to old age, including the tendency to overmedicate, in a review it makes of the situation of aging and related prejudices.
The elderly quite often receive large prescriptions, which then cause cascading effects, particularly in dementia pathologies and depression:
"The first drug causes a side effect, which, interpreted as a new pathology, induces the prescription of a new treatment causing in turn another side effect. "
Overmedication is "all the more challenging because the elderly are more susceptible to side effects". There is a resultant of accidental falls, episodes of confusion, responsible for a quarter of hospitalizations.
This thesis offers something to discuss confidently and reasonably about some prescriptions that may be excessive. This can be the case for diagnoses of dementia: mental confusion can be natural but also a side effect of a drug.
"If drug prescription is the almost absolute rule, in Wallonia as in Belgium and everywhere in the world, it should be remembered that there is no curative treatment for dementia pathologies. Although certain drug treatments are necessary because they act adequately on the symptoms associated with the disease, the 111B report of the Federal Centre for Expertise in Health Care concluded that the efficiency of currently available drugs is limited, and the reimbursement of some of them is even questioned. Thus, the efficiency of pharmacological approaches remains questionable even today."
Furthermore, if a diagnosis results in a person remaining in the hospital, in revalidation, or leaving for an institution, this is far from trivial, when one knows how quickly old age can upset a balance.
Thus, it is the question of autonomy and independence. To be autonomous is to govern oneself or follow one's own law. To be independent is to be able to perform the tasks of daily living without assistance: washing, dressing, eating, cooking, cleaning; and to be able to get around.
Before the establishment of pension funds, the elderly were financially dependent on the children who had raised them. There was cohabitation over several generations.
Since then, in some countries, families can be supported either in maintaining a person who becomes dependent at home, or in his or her "institutionalization": his or her care in an institution that houses him or her, feeds him or her, and handles his or her activities and care.
A majority of people do not wish to enter an institution, which moreover has a very significant cost for both individuals and states.
The research details two modalities supporting the maintenance of dependent older people in their homes. The first is ergotherapy, the second falls under gerontotechnology, ICT adapted to geriatrics.
Occupational therapists are "paramedics who accompany people with physical, psychic and/or social dysfunctions in order to enable them to acquire, recover and/or maintain optimal functioning in their personal lives, in their professional occupations or the sphere of their leisure activities through the use of concrete activities related to them and taking into account their potential and the constraints of their environment. "
It considers the human person as a global being and takes into account his or her rhythms, activities and the balance between these elements. The thesis approaches his intervention through environmental adaptation alone, while putting it well within his perspective of supporting the person's occupational performance and life balance.
The discipline is appealed to for its overall diagnosis and concrete improvements such as safety enhancements (anti-slip systems, grab bars), its assistive technologies (from the jar opener to the medical bed), and more significant modifications in architectural design.
From the perspective of gerontotechnologies, the author has reported on the measurement of activity through the actigraphy method, also known as actimetry. This method consists in the implementation of an instrument that detects activity.
The simplest of these devices and the easiest to incorporate into one's daily life is a bracelet. With a more rudimentary appearance, it's a bit like the well-known watch that alerts you if you haven't met your exercise "quota."
Actimetry records body movement and allows for activity analysis. This can be daytime, or nighttime to analyze the amount of sleep and its phases. It also measures the intensity of effort.
Thus, we learn that a walk with a dog is more intense than a walk without a dog and that the latter is equivalent to a household activity.
These two methods are considered relevant tools for prevention, to avoid or delay the departure to an institution, or in any case, that this one is less of an emergency solution, badly experienced as often the brutal changes.
"Research has solidified the value of the health care system turning to prevention strategies and services. "
In addition, to quench the thirst for curiosity, a list of gerontotechnology functions and their tools:
Illustration: sabinevanerp from Pixabay.
Patrick Maggi, Home Occupational Therapy and Actimetry. Two modalities for prevention of institutionalization of persons aged 65 years and older. Public Health Sciences, Liege, 2021.
Thesis available for consultation at: https://orbi.uliege.be/handle/2268/255187
Dominique Argoud, Are Gerontotechnologies a Social Innovation?
https://www.cairn.info/revue-retraite-et-societe-2016-3-page-31.htm
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