Lhe major challenges inherent in demographic aging have become obvious and the social, medical and economic issues associated with them have given rise in recent months to several reports setting out proposals that should make it possible to overhaul old age policies, both in the field home care and primary care as well as hospitals and medico-social services and establishments.
However, understanding the issues related to this demographic transition while ignoring the contemporary epidemiological transition runs the risk of minimizing the impact of chronic diseases, the main determinant of the loss of functional autonomy and dependency. Indeed, if the increase in life expectancy has constituted a veritable revolution in recent decades, it is associated with a significant increase, in the highest age groups, of chronic diseases and of the incapacities and handicaps which result from them. result.
Faced with these inseparable demographic and epidemiological issues, public policies aimed at old age must promote responses adapted to the plurality of aging modes by avoiding confusing what is a matter of social or economic responses and what is a matter of the medical field and more. largely health.
Three ways of advancing in age
For the sake of efficiency, they must differentiate the actions to be implemented taking into account the phenotype [ensemble des caractères apparents d’un individu, par opposition au génotype] associated with the three main commonly accepted modes of aging: high-level or robust ageing, characterized by the preservation of functional capacities; aging with weakening, which is distinguished by the reduction of the latter without it being possible to attribute this reduction to a disease of the organ concerned; and aging accompanied by the emergence of chronic diseases, the probability of which increases with age. The latter constitute the main cause of functional disabilities and consequently of the loss of autonomy.
Thus, neuroevolving conditions (Alzheimer’s disease and related conditions) alone are the cause of more than three quarters of dependency situations in France and concern nearly three quarters of residents in accommodation establishments for dependent elderly people. (Ehpad). They also represent the first factor limiting the possibilities of home support and therefore the first determinant of orientation towards an Ehpad.
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