Eng'âge

1 Keeping people busy as they age to promote their health A. The challenges of enabling every citizen to age in good health In France, life expectancy is increasing and the number of people aged over 65 is rising rapidly (Papon, 2024; Thalineau & Nowik, 2022). However, disability-free life expectancy is not rising as fast. In 2022, it was 65.3 years for women and 63.8 years for men, compared with 64.5 years for women and 62.8 years for men in 2008 (INSEE, 2024). There has even been an increase in the number of long-term illnesses (ALD), such as cardiovascular and respiratory diseases, cancer and dementia, which is leading to a loss of autonomy and generating economic and financial costs (DREES, 2018). France only ranks eleventh in Europe, even though it is first in terms of longevity (Santé publique France, 2022). In fact, 70% of people over the age of 85 suffer from a chronic health problem such as Alzheimer's or Parkinson's disease or various functional limitations (physical, sensory or cognitive) that lead to a loss of independence (Brabant-Delannoy, 2019). As a result, the French population is living longer, but not necessarily in good health. The older people get, the more likely they are to need human, material and financial assistance (Monod, 2018) which, multiplied by the number of people concerned, is set to increase further (INSEE, 2020), poses a major economic and social problem for society. While ageing is a physiological process that begins at birth, it can be more or less rapid depending on an individual's lifestyle (Coudin, 2010; Guilbaud et al., 2020), social environment and working conditions (Thalineau & Nowik, 2022, p13-28). To enable as many people as possible to age as long as possible without disability and in good health, it seems appropriate. To achieve this, we need to promote lifestyles that are conducive to good health and prevent the onset of age-related diseases as far as possible (Brabant-Delannoy, 2019). A holistic vision of health takes into account all these individual components, linked to the living environment, systems or overall context in which the person evolves (Ministère de la Santé et des Services sociaux du Québec, 2010; Brabant-Delannoy, 2019). B. Particular vigilance in maintaining occupations in old age Occupation is one of the determining factors in individual health. They are defined as ‘everything people need to do, want to do or need to do in the sleep-wake continuum, individually or collectively’ (Wilcock & Hocking, 2024, p.xi). They constitute our habits of life, and the ways in which we carry out each of these occupations has an irreversible impact on our health (Wilcock & Hocking, 2024, p.xii). The way we carry out our occupations varies from birth to the end of our lives, depending on a number of factors, such as our physical and social environment, our motivation and the meaning we give to our occupations. Occupations may vary in frequency, duration, nature, conditions, safety, satisfaction or effectiveness (Fisher & Marterella, 2019). When the performance of one or more occupations is prevented, this can lead to a reduction in quality of life, well-being and health (Lefrançois, 2018). From the age of 60 onwards, occupations are likely to adapt to events associated with advancing age, such as retirement, physiological ageing, widowhood or entry into a home for the dependent elderly (EHPAD) (Caradec, 2009). Given the impact of occupations on people's health, it seems vital to enable everyone to carry out their occupations satisfactorily, safely and effectively for as long as possible. 2. Primary prevention and health promotion In France and internationally, health policies have long recognised the importance of anticipating and promoting healthy ageing (Libault, 2019; WHO, 2023; Van Wymelbeke-Delannoy, 2022). Health promotion is defined by the Ottawa Charter as ‘a process which enables people to increase control over, and to improve, their own health’ (WHO, 1986). It is aimed at the whole population and acts on all the determinants of health (Ministère de la Santé et des Services sociaux du Québec, 2010). Health promotion complements primary prevention, which refers to ‘all measures aimed at avoiding or reducing the occurrence or incidence of disease, accidents and disabilities’ (WHO, 1948), such as the risk of falls (Fundenberger, 2022; HAS, 2024) or the onset of cognitive disorders (Amieva, 2018; Boujut & Belleville, 2019). Many authors argue that involving people over 60 in health promotion and prevention initiatives is a relevant solution for promoting health and staying at home for as long as possible, avoiding isolation and continuing to take action (Clark et al., 2016; Libault, 2019; Uemura et al., 2021). According to Cusset et al (2021), this could also lead to a reduction in public spending on healthcare. Promoting healthy lifestyles and preventing lifestyle-related health problems would therefore appear to be an interesting solution for enabling as many people as possible to age independently for as long as possible. Analysing at-risk lifestyle habits and adapting the way occupations are carried out is one possible way of taking this approach (Morel-Bracq et al., 2023). 3. Developing primary prevention and health promotion programmes for the over-60s A. The rise of primary prevention and health promotion for the over-60s in France In France, since 2007, a succession of ‘ageing well’ plans have encouraged the introduction of prevention and health promotion initiatives aimed at people aged 60 and over (Van Wymelbeke-Delannoy, 2022). A number of Agirc-Arcco organisations (Association des Centres de Prévention Agirc-Arrco, n.d.) and the Caisses d'Assurance Retraite et de la Santé au Travail (CARSAT) are currently organising group workshops focusing on prevention themes, giving participants the opportunity to reflect on issues specifically related to ageing, such as preventing falls, memory, physical activity, sleep, nutrition and stress. ICOPE (Integrated Care for Older People) (WHO, 2019) offers screening for frailty in six areas: memory, nutrition, vision, hearing, psychology and mobility (Tavassoli et al., 2022). While ICOPE can detect problems as early as possible and refer people to a healthcare professional if necessary, it does not take into account people's lifestyle habits. This is what makes TaPasS (Temps d'Accompagnement Prévention activités signifiantes et Santé) so special, as it is aimed at a group of around ten people based in the same area. TaPasS enables each participant to explore their lifestyle habits and the way in which these impact on their current and future health by combining group and individual sessions over a period of six to eight months (Morel-Bracq et al., 2023). Based in particular on the science of occupation, health literacy, empowerment and peer exchange, TaPasS offers participants the opportunity to analyse, understand and adapt their lifestyle habits to enable them to age as well as possible (Morel-Bracq et al., 2023). During the first three group meetings, the participants discuss their occupational balance and their relationship with health, which enables them to determine together the themes they wish to address during the modules (for example, moving around safely, activating their body, interacting with others, cooking and eating, resting and sleeping, using digital tools, etc.). To meet the needs identified, the coordinating occupational therapists draw on the specific characteristics of the people and the area (Morel-Bracq et al., 2023). However, a number of difficulties have been identified in rolling out health promotion and prevention initiatives: organisational difficulties, the need to take account of the specific complexity of each area, the lack of evaluation of existing programmes (Clet et al., 2024), and also the lack of interest among people in taking an interest in health issues, even though they consider themselves to be in good health (Van Wymelbeke-Delannoy, 2022). The deployment of TaPasS is not immune to these difficulties, which are particularly reflected in the difficulty of engaging target individuals in TaPasS (Soum-Pouyalet et al., 2021). B. L’engagement dans les actions de prévention de la santé comme une limite observée En 2021, Coley et al. S’intéressent à la participation et l’adhésion à un programme de prévention de la démence menée en France et à Monaco pendant trois ans. Les résultats montrent que les personnes les plus âgées et les personnes les plus anxieuses participaient moins au programme alors que c’est précisément à eux qu’il s’adresse. En revanche, la présence d’antécédents familiaux en lien avec la démence ou d’une peur de cette maladie favorisaient la participation (Coley et al., 2021). Il semble alors que la participation soit favorisée par la présence d’un facteur de risque important identifié par le participant. Les résultats de l’étude états-unienne menée par McMahon et al. (2022) corroborent ces résultats : une évaluation de l’engagement des personnes âgées dans un programme de prévention des chutes nommé « Strategies To Reduce Injuries and Develop confidence in Elders » (STRIDE) a été menée en s’appuyant sur le cadre « Patient and Family Continuum Engagement » (McMahon et al., 2022). Elle conclut que l’engagement des personnes dans le programme dépend du niveau de risque de chute, mais également du partenariat mis en place entre la personne et le professionnel de santé qui l’a orienté vers le programme. Les auteurs suggèrent alors la nécessité d’identifier en amont de l’engagement dans le programme les obstacles sociaux et organisationnels à l’engagement de chaque participant. De plus, l’engagement favorise le changement (Guéguen & Joule, 2010) et l’adoption de nouveaux comportements, de nouvelles habitudes (Meyer, 2013). Ce dernier est donc un prérequis à la participation à une action de promotion de la santé. 4. Occ

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