What if age doesn’t mean anything anymore? What is the true measure of ageing?

A person’s age on their identity card doesn’t tell the whole story, far from it! This is one of the key lessons highlighted by Professor Antoine Piau, Medical, Ethics and Health Innovation Director of the Clariane Group. He calls on us to look beyond appearances to gain a better understanding of what ageing really is. Behind chronological age lies a more complex reality: biological age, which reflects our true state of health. Let’s explore this concept, which is still relatively unknown but essential for rethinking how we care for the elderly.

The emergence of a holistic approach to ageing

In the 1980s, the field of geriatrics underwent its first revolution with the introduction of comprehensive gerontological assessment. Rather than treating diseases alone, this approach encourages us to consider the person as a whole: memory, nutrition, mobility, psychological balance, etc. This marked a decisive turning point: care becomes synonymous with supporting all aspects of ageing, far beyond the affected organ.

The second revolution: understanding frailty

But one question remained unanswered: why do two people of the same age react differently to the same situation? Why does one recover after a fracture, while the other slides into a spiral of loss of independence? For a long time, people talked about ‘sliding syndrome’, without knowing its exact causes.

In the early 2000s, researcher Linda Fried shed new light on the issue with the concept of frailty. It identifies five indicators that predict an increased risk of dependency: slow walking, unintentional weight loss, perceived fatigue, decreased muscle strength and reduced daily physical activity. A person with at least three of these signs is considered frail. They are still independent, but vulnerable. This explains what appears to be a sudden decline in health following a minor stressful event (viral infection, fall, moving house).

Frailty, robustness, dependency: three profiles for better action

This discovery makes it possible to distinguish three categories of the elderly:

• the robust, with no signs of frailty, who are ageing harmoniously;
• the frail, who are in an unstable equilibrium and at high risk of decline;
• the dependent, who have already lost their independence.

A simple and powerful indicator: walking speed

Among the indicators of frailty, one criterion stands out: walking speed. So much so that some experts suggest evaluating it as a ‘vital sign’, in the same way as pulse, body temperature and respiratory rate.

Why? Because it is predictive of many adverse health outcomes: hospitalisation, loss of independence, post-operative complications and even mortality. It is not the speed itself that matters, but how it changes over time. A progressive, silent decline can signal a deterioration in overall health and requires action.

Towards a more personalised healthcare

Ultimately, the concept of frailty is changing our relationship with age. It encourages us to shift from a treatment-based approach to a proactive approach. It redefines priorities: identifying, preventing and supporting, rather than repairing too late. Above all, it encourages the personalisation of care based on actual functional abilities rather than chronological age or a simple accumulation of diagnoses.

By integrating functional assessment into our practices, we can identify signs of frailty early and intervene in a targeted manner. This proactive approach helps preserve the independence of the elderly and improve their quality of life. In short, it is not just a question of prolonging life, but of ensuring that those extra years are lived in the best possible conditions.

And at Clariane? As part of our partnership with the Toulouse University Hospital, we are committed to rolling out the ICOPE programme in our Inicea rehabilitation and mental health clinics, as well as in our Petits-fils branches in the Occitania region. Launched at the end of 2019 by the WHO, the ICOPE programme aims to prevent loss of independence by identifying early the risk factors for loss of independence before frailty sets in.

It is based on an integrated and personalised approach, centred on evaluating and monitoring six essential capacities for healthy ageing: mobility, memory, nutrition, vision, hearing and psychological well-being. Because it offers early screening, the ICOPE programme is essential for the care of tomorrow.