Resulting from an overall increase in life expectancy over the age of 65, population aging is a global phenomenon. In the European Union, people aged 65 or over represent 19.7% of the population, compared to 16.2% 15 years ago. However, ensuring the healthy aging of our populations will remain a challenge in the coming years. Although it has increased by a little over a year in the last decade, there is still room for improvement: at the age of 65, a French woman can expect to live for another 23.2 years, but on average she will live without disability for only 11.2 years. In comparison, in Sweden, women can expect to live on average 17 years after the age of 65 without disability. Consequently, population aging raises major questions about how we should adapt care and prevention systems within our society. Institut Montaigne has just published a report titled "Bien-vieillir: faire mûrir nos ambitions" (Healthy Aging: Maturing Ambitions), which puts forward recommendations for making this demographic transition a success.
Population aging: a global phenomenon
People in OECD countries have gained, on average, 10 years of life expectancy since the 1970s. The question is: are our health systems allowing for the best use of these additional years? In many countries, this is not yet the case.
Population aging raises major societal questions: How can we effectively deal with individuals’ loss of autonomy? How can we adapt cities to the needs of older people? How can we improve the well-being (or meet the needs) of family carers, who often provide most of the assistance needed by older people? What role should the older people have; how can we help them remain an active part of our societies? How can we finance the years after retirement, especially for the period when individuals are no longer robust? How appropriate and effective are the solutions currently available?
These questions are addressed by a large body of international research, from a wide range of disciplines: geriatrics, epidemiology, public health, economics, management, political science and sociology. This affords us a fairly clear understanding of the issues. We know that loss of autonomy in older populations is often a very progressive process, and can be prevented. The markers of aging are well identified: loss of muscle mass (sarcopenia), reduction in walking speed, nutritional problems, and so on. We know that poverty, lack of education, and withdrawal are major determinants of disability risks. The consequences of loss of autonomy are also better understood: we know that frail older people often are "high needs and high costs" patients, and that for the most part their needs are met by informal caregivers networks.
These issues have a major impact on families. In France, as in many countries, informal caregivers are the main care providers for frail older people. This often creates imbalances between family members, particularly with siblings of different genders, as carers are usually women who make significant professional sacrifices to look after their relatives. Working carers generally experience loss of income due to reduced working hours or shortened careers. This is in addition to the (sometimes very heavy) psychological burden associated with the role, as carers often sacrifice their own leisure activities and are more likely to suffer from depression, among other issues. There are also significant inequalities between families, as wealthier households are better able to employ private professional help to relieve family carers.
The main challenge: preventing loss of autonomy
In the face of these challenges, France, like the majority of OECD countries, has chosen to promote healthy aging policies, which aim to effectively prevent loss of autonomy, provide assistance that is centered around people’s interests, mobilize new technologies to identify needs and monitor diminution of autonomy, and counter social isolation. In many respects, France is among the most advanced countries. For example, it is a pioneer in detecting loss of autonomy and is one of the OECD countries that devotes the largest share of its GDP (2.4%) to long-term care. Nevertheless, a broader international comparison reveals several shortcomings within the French system.
One important point is that public assistance in France does not focus enough on individuals’ interests. Compared to several OECD countries, French public assistance is less generous in covering at-home as opposed to institutional care, even though older persons typically prefer to age at home.