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25 November 2021
Despite an abundant volume of parliamentary studies, research and administrative reports
published over the past decade, the prevention of loss of independence still occupies a
marginal place in public policies. While the findings and actions required to offer effective
prevention are generally accepted, the Court has sought to identify sticking points, and to
suggest measures for operational progress that would improve the lives of a quarter of the
French population
almost a third in future. The survey published today covers the stage
prior to the loss of independence, in the field of prevention, and makes six
The French case: living longer, but not necessarily in better health
France is experiencing an ageing population similar to that of other OECD countries
phenomenon which will tend to accelerate with the many
“baby boomer” classes, now old
enough to be affected by a loss of independence (over 85 years). France had 100 centenarians
in 1900, and 1,120 in 1970; the number is currently 26,300, and will be approaching 200,000
by 2060. In view of this demographic change, it is vitally important to prevent the loss of
independence. In France, the life expectancy of 65 years is admittedly higher than in other
European countries, but years of healthy life represent only half of this time
a finding that
turns out to be more negative than in eleven European countries. There is therefore room for
improvement, because although loss of independence increases statistically with age, it is not
an inevitable consequence of ageing. In addition, beyond the individual and collective benefit
for the people concerned, the Court calculated that a gain of one year in life expectancy
without disa
bility would represent a saving of nearly €
1.5 billion in health insurance
The disparate nature of stakeholders reduces the benefits of a policy that is otherwise
generally accepted in principle
The stakeholders participating in the management of the prevention of the loss of
independence are particularly numerous: departmental councils, pension funds, regional
health agencies, primary health insurance funds, the
Agence nationale de l’habitat
agency, municipalities and inter-municipal cooperation agencies, regional councils, social
landlords, mutual bodies, associations, etc. It is true that a process of restructuring and
rapprochement between organisations has begun; yet the system as a whole remains
multifarious and administratively complex. This proliferation of contacts exposes users to a
very real risk of discouragement. The content of prevention policies is, however, generally
accepted: prevention measures implemented from the age of 40-45 and reinforced at the time
of retirement, the promotion of the importance of engaging in a physical activity, or even
home support thanks to adapted housing. The Court also observed that in France, the
prevention of falls in the elderly (causing more than 10,000 deaths of elderly people each year)
remains a relatively neglected area of prevention. To date, there has only been the faintest
glimmer of rising awareness in two areas of prevention: the fight against isolation among the
elderly (an aggravating factor in loss of independence), and initiatives to raise health
professionals’ awareness of screening for pathologies in old age and techniques for
maintaining functional abilities.
Improved structure for prevention
Prevention services thus remain disparate, and provide unequal levels of support. To
strengthen this area, the Court recommends building a tiered service, an initial level of which
would consist of delivering general information through communication campaigns targeting
the general public, improved coordination between information at national and local
authority levels, and also the creation of a telephone information system. A second level
would introduce a more targeted policy, providing in particular for home visits by
professionals trained in prevention issues to elderly people requesting this service. Finally, a
third level would be reserved for the most vulnerable and isolated people, with assistance
plans implemented through social measures by pension funds. At the same time, the Court
suggests increasing housing adaptation work, while simplifying assistance and standardising
procedures. It also recommends that the Ministry of Social Support and Health set out an
ambitious public health goal aimed at reducing falls and deaths. To this end, regional health
agencies would be equipped with tools such as a systematic statistical register of falls.
Read the report
Emmanuel Kessler
Head of Communications
01 42 98 55 62
Julie Poissier
Head of press relations
01 42 98 97 43
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Cour des comptes