Beyond longevity: healthy longevity
Authors: Alain Putot, Sophie Putot, Arthur Hacquin, Patrick Manckoundia
Journal: The Lancet Healthy Longevity (2021)

The current global health crisis has exposed, if it were not already known, the clear shortcomings in the health-care system in the care of the most vulnerable, and in particular older adults. Although the COVID-19 pandemic is far from being behind us, we can already start to examine the lessons to be learned and the areas of improvement for geriatric care. Evelyne Bischof and colleagues recently highlighted the urgent need to implement medical education focused on the early diagnosis and prevention of age-related diseases.1Bischof E Scheibye-Knudsen M Siow R Moskalev A Longevity medicine: upskilling the physicians of tomorrow.Lancet Healthy Longev. 2021; 2: e187-e188Summary Full Text Full Text PDF Scopus (1) Google Scholar We would like to stress that older individuals also need, perhaps above all, personalised care adapted to their health status. In other words, even if scientific knowledge about the ageing process were to be further developed and better shared among caregivers, first we need geriatric culture to spread throughout our care settings. We define geriatric culture as entailing all the knowledge and skills focused not so much on longevity but more on the wellbeing and health, as defined in the WHO Constitution, of older patients with comorbidities. Care should remain focused on patients' desires and quality of life rather than solely on their prognoses, and in this context care extends beyond the notion of longevity. This approach involves a better understanding of the factors associated with longevity and with age-related diseases and, more importantly, the somatic, psychological, and social aspects that are involved in the care of older patients. This is especially important because, in addition to the biological dimension, it has been shown that both psychological2Jacobs JM Maaravi Y Stessman J Optimism and longevity beyond age 85.J Gerontol A Biol Sci Med Sci. 2021; glab051Crossref PubMed Scopus (4) Google Scholar and social3Terraneo M The effect of material and social deprivation on well-being of elderly in Europe.Int J Health Serv. 2020; 51: 167-181Crossref PubMed Scopus (4) Google Scholar wellbeing are associated with increased longevity. In addition to an overall low level of knowledge among caregivers about the ageing process, there is also progress to be made in developing practical skills and individualised care approaches, from geriatric intensive care (still in its infancy) to palliative care (largely underdeveloped). Unfortunately, while the current inadequacy of geriatric education is universal, it is especially noticeable in low-income and middle-income countries.4Keller I Makipaa A Kalenscher T Kalache A Global survey on geriatrics in the medical curriculum. World Health Organization, Geneva2002Google Scholar Furthermore, the features of clinical presentation and therapy that are specific to older patients are not well known by doctors in training; they are often unaware of the existence of such features. This results in a lower quality of care for older patients. Training in geriatrics and gerontology suffers from an evident lack of appeal,5Meiboom AA de Vries H Hertogh CMPM Scheele F Why medical students do not choose a career in geriatrics: a systematic review.BMC Med Educ. 2015; 15: 101Crossref PubMed Scopus (82) Google Scholar contributing to the low number of geriatricians in training. For example, in France, geriatrics is one of the least popular medical disciplines to be chosen for internships. However, students assigned to geriatric settings frequently recognise the great richness of this specialty, in terms of both the medical and human aspects. There is another paradox: geriatrics is recognised as one of the most challenging medical disciplines and yet is often chosen for internships by lower-ranked students. The preconceived notions and lack of awareness about this discipline therefore need to be urgently addressed. There are several available tools with which to do this. One such tool is medical internships, during which the richness of the discipline can be conveyed.5Meiboom AA de Vries H Hertogh CMPM Scheele F Why medical students do not choose a career in geriatrics: a systematic review.BMC Med Educ. 2015; 15: 101Crossref PubMed Scopus (82) Google Scholar In order to be instructive and attractive for trainees, these internships should involve physicians accompanying trainees at the patient's bedside. This requires the active and willing involvement of geriatricians, who are often very pleased to participate in the practical teaching of those who will succeed them and to be able to pass on their skills. Another approach is the implementation of courses in the medical curriculum that focus on the care of the older population. This requires above all an urgent reconsideration of the pedagogical materials and methods that currently prevail in geriatrics, which sometimes alienate students from this fascinating discipline as a result of being too far removed from clinical practice.6Masud T Blundell A Gordon AL et al.European undergraduate curriculum in geriatric medicine developed using an international modified Delphi technique.Age Ageing. 2014; 43: 695-702Crossref PubMed Scopus (70) Google Scholar This approach also requires a corresponding increase in the number of academics in geriatrics, since the glaring lack of academics has been shown to contribute to the specialty's lack of appeal.7Curran MA Black M Depp CA et al.Perceived barriers and facilitators for an academic career in geriatrics: medical students' perspectives.Acad Psychiatry. 2015; 39: 253-258Crossref PubMed Scopus (18) Google Scholar The building of bridges between disciplines is also key to the development of geriatrics, since it is a discipline that is essentially transdisciplinary. This approach should be considered in particular by universities, by including geriatrics in the curricula of other medical specialties (there are no disciplines that do not have age-related elements), and conversely by including knowledge from other specialties in geriatrics curricula; adopting an interdisciplinary approach is essential to guaranteeing excellence in care, regardless of age. However, it is likely that older comorbid patients have more difficulty accessing certain types of specialist care, particularly when these patients have major neurocognitive disorders.8Shaver NS Lapenskie J Smith GA Hsu AT Liddy C Tanuseputro P How often, where, and by which specialty do long-term care home residents receive specialist physician care? A retrospective cohort study.J Appl Gerontol. 2020; (published online Feb 6.)https://doi.org/10.1177/0733464819901255Crossref PubMed Scopus (4) Google Scholar Difficulty in accessing care could be partly due to practical difficulties (for example, making medical appointments often requires the assistance of a third party in the case of neurocognitive disorders) or organisational obstacles (geriatric units are often still separate from the rest of the hospital). Above all, there is still a prioritisation by physicians for younger patients without disability, for whom care might be deemed more urgent, if not more justified. The presence of such ageism in health care has sadly been confirmed during the COVID-19 pandemic.9Cesari M Proietti M COVID-19 in Italy: ageism and decision making in a pandemic.J Am Med Dir Assoc. 2020; 21: 576-577Summary Full Text Full Text PDF PubMed Scopus (91) Google Scholar It is urgent to remedy this situation, and only the training of future generations of caregivers will allow us to turn the page on these outdated decision-making criteria.10Burnes D Sheppard C Henderson Jr, CR et al.interventions to reduce ageism against older adults: a systematic review and meta-analysis.Am J Public Health. 2019; 109: e1-e9Crossref PubMed Scopus (151) Google Scholar We declare no competing interests.