Today, people over the age of 60 account for one-quarter of the population and could account for one-third by 2050. While life expectancy in France after age 50 is the highest in the EU for women (37.4 years vs. 34.9 years in the EU in 2014; a gain of 2 years over 10 years), the number of years lived in good health remains lower than in several other countries.

An increase in the number of dependent older adults by 2060

In old age, recent studies show a favorable trend in disability-free life expectancy in recent years compared to previous decades, but a less favorable trend among people around retirement age. It therefore appears urgent to take action to slow this unfavorable trend and improve quality of life as people age. Recent estimates suggest an increase in the number of dependent older adults from 1.2 million in 2012 to 2.3 million by 2060.

Overview of the Health of French People Over 65

• Among the leading chronic diseases with a heavy burden are cardiovascular and cerebrovascular diseases, major neurocognitive disorders (such as Alzheimer’s disease), chronic respiratory diseases (such as COPD), diabetes, and lung cancer.

• More than 1.4 million people over the age of 60 living at home can be considered dependent.

• One in two dependent individuals currently lives in a care facility.

• An increase in the prevalence of chronic diseases is expected in the coming years due to population aging and improved patient survival.

Preventing the loss of independence: a priority

Since dependency is difficult to reverse, preventing and preserving independence in daily activities as early as possible—before the first signs of disability appear—has become a public health priority.
To this end, identifying individuals at risk of losing independence is crucial. Functional decline results from three concurrent phenomena: biological aging, unhealthy behaviors, and the onset and progression of one or more chronic diseases.

Biological aging gradually transforms a healthy adult into a vulnerable individual by diminishing their overall physiological reserve capacity. This phenomenon makes the individual more vulnerable to stress and places them at high risk for adverse outcomes such as the onset of chronic diseases, loss of independence, institutionalization, and death. The concept of frailty is now widely used to operationalize this phenomenon of vulnerability to stress. In France, the prevalence of frailty is estimated to be between 10% and 13% among those over 55 years ^{of age1,2}. This prevalence increases exponentially with age, is higher among women, and is marked by significant social inequalities. The identification and opportunistic screening for frailty in individuals over 70 have been recommended by the HAS since 2013³. Indeed, preventive measures are available to reduce the risk of a negative progression toward dependency or the occurrence of serious events such as falls⁴^,⁵.

Furthermore, the identification of frailty is now possible within the National Health Data System (SNDS), using an algorithm developed by Santé publique France. This algorithm, based on medical conditions, healthcare utilization, and geriatric syndromes, calculates the prevalence of frailty among those aged 55 and older and identifies frail individuals among those aged 75 and older. These prevalence rates, stratified by age and sex, as well as the geographical distribution of frailty in mainland France, are presented in the Frailty Bulletin.

At the same time, as people age, many chronic conditions lead to disability and dependence; these include cancers, cardiovascular diseases and risk factors, mental illnesses, and neurodegenerative diseases, with the latter carrying the heaviest burden of dependence. Finally, what particularly characterizes the elderly population is polypathology or multimorbidity^6,7, a consequence of the accumulation of risk factors over time. In the report “Health Challenges…”^⁸, the first section is devoted to the epidemiology of chronic diseases linked to loss of independence. A detailed review of risk factors, estimates of prevalence and incidence, and their trends is provided.

Prior to the identification and management of frailty and chronic diseases, it is possible to address health determinants in midlife to promote healthy aging. Indeed, a body of evidence from observational studies shows associations between positive health behaviors (low tobacco and alcohol use, regular physical activity, etc.), control of cardiometabolic risk factors (hypertension, diabetes, etc.), and healthy aging. Furthermore, certain intervention studies on these factors, though limited, appear promising. Consequently, it is now recommended to address these determinants starting in midlife to prevent loss of independence.

Promoting healthy aging: Santé publique France’s program and initiatives

The massive aging of the population in the coming years represents a major social and public health challenge. The program developed by Santé publique France aims to provide knowledge to address the various factors that promote healthy aging in the long term, including:

• monitoring of chronic diseases, injuries (falls), mental health, and determinants;

• the development of integrated indicators of overall health designed to identify populations at risk of losing their independence (indicators of frailty and multimorbidity).

The prevention and health promotion initiative focused on the transition to retirement, co-developed by Santé publique France, is now managed by the inter-fund pension system through:

• providing information to those concerned (older adults and caregivers), particularly through the pourbienvieillir.fr website and social media (Facebook);

• knowledge transfer to professionals, particularly via the professional section of the pourbienvieillir.fr website.