Screening to better prevent: hearing, vision, memory

The discussions revealed a conviction: “useful” longevity isn’t about living longer, but about increasing the number of healthy years by minimising the time spent living with disabilities. This would be the benefit of a new, more proactive, more coordinated and more local type of offering: “longevity clinics” (or, as Professor Fraysse suggests, “independence clinics”), designed as an operational arm of ICOPE prevention.

As Professor Balardy reminds us, the approach put forward by the IHU Health Age is not a spectacular “anti-ageing” approach. It aims for a pragmatic course of action, based on recommendations and centred around assessing intrinsic capacity (such as mobility, nutrition, hearing, vision, cognition and psychological well-being). The challenge is clear: to identify changes in trajectory early on and take action on modifiable factors (physical activity, sedentary lifestyle, sleep, stress and lifestyle habits), before disease takes hold.

Another central point is that “longevity clinics” must avoid the pitfall of only being accessible to a few people. The goal is the opposite: to make prevention fully accessible, useful and reasonable, based on simple tools (self-questionnaires, rapid screenings) and transparent pathways.

After discussion with French and international experts, 50 years old appears to be a turning point:

• this is often when we become more receptive to prevention;
• it’s also the period when the major risk curves (for cardio-metabolic issues, cancer and neurodegenerative disease) begin to increase;
• and where, in cohort studies, we observe the first measurable decline in intrinsic capacity – at an age when we still have real room for action.

The idea is not to have everyone attend a specialised consultation, but to filter in an intelligent way: beginning with tests and questionnaires, then guiding relevant patients towards a prevention consultation or more structured care where this offers real benefits.

Professor Bernard Fraysse emphasises that hearing disorders do not exist in a vacuum. They can lead to social isolation, communication difficulties and psychological repercussions and be associated with balance disorders. This is why he has proposed a “constellation”-like system involving ENT doctors, audioprosthetists, vestibular physiotherapists, speech therapists and orthoptists to treat the patient’s overall situation.

Two key messages stand out:

• Rehabilitating hearing can have effects beyond the ear: Professor Fraysse cites data showing a reduction in cognitive decline in a randomised trial (ACHIEVE).
• Fall prevention is not just about “moving more”: it is also crucial to diagnose instability and its causes (which are partly treatable), then coordinate care.
  Finally, despite the French government’s “100% Santé” reform, early access remains a challenge: financial support is not enough if it is not accompanied by targeted messages and pathway solutions, especially in the most disadvantaged areas.

Finally, despite the French government’s “100% Santé” reform, early access remains a challenge: financial support is not enough if it is not accompanied by targeted messages and pathway solutions, especially in the most disadvantaged areas.

As Professor Bruno Vellas highlights, Alzheimer’s disease is the area of prevention that causes the most concern. Recent advances have opened up a new possibility: using blood biomarkers to identify risk profiles and to better target prevention. He proposes a cautious and educational approach, targeted at people who complain about their memory or have a family history, explaining that it is a risk factor – like high cholesterol – and not a diagnosis of disease.

In parallel, the round table highlighted the benefits of non-drug interventions (such as adapted physical activity and multi-domain programmes) and the need to find a “mixed” model (combining face-to-face and digital tools) to reconcile efficiency, cost and long-term adherence.

Professor Antoine Piau describes a very concrete challenge: our health system experiences high demand for curative medicine and it lacks time for prevention. However, in local areas, there are already often underused resources, such as technical platforms and multidisciplinary teams at medical, post-acute & rehabilitation care facilities, medical and social facilities, etc.

Clariane’s aim is twofold:

1. To generalise ICOPE screening (Step 1): by the end of 2026, the goal is for 100% of psychiatry patients aged 50-plus and medical, post-acute & rehabilitation care patients aged 60-plus in Clariane facilities to undergo Step 1.
2. To continue beyond screening by, at some sites, rolling out Steps 2, 3 and 4 (mobility rehabilitation, nutrition, fall prevention, etc.), where the need is insufficiently covered, working together with local stakeholders.
   All of this must be delivered with resources and funding remaining unchanged, by tailoring the structure and role of facilities to make them drivers of public health.

All of this must be delivered with resources and funding remaining unchanged, by tailoring the structure and role of facilities to make them drivers of public health