The process of losing autonomy

The process of losing autonomy

G Bellis, N Brouard, MH Cazes, E Cambois, F Meslé, A Parant, JM Robine

As well as anticipating care needs for dependent people, it is important to analyse the mechanisms that lead to dependency and to identify the determinants that cause some people to require assistance while others are able to maintain a satisfactory level of activity.

Within this framework, our research seeks to break down the process that leads to dependency in order to understand its stages and consider how to intervene. We study the links between chronic disease and disability among the most elderly people to show the extent to which situations and needs vary and require tailored responses. We also attempt to identify the factors that enable people to maintain their activities and autonomy.

From disease to dependency

E. Cambois has developed an approach to the links between disease and disability in the general population. Her analyses provide framework data and can be used to compare the situations of people suffering from chronic disease. They are an opportunity to analyse the determinants of disability and disparities. In particular, this research shows that for people with various diseases, pain, fatigue and discomfort increase the risk of the disease leading to disability. This research suggests the importance of evaluating health status holistically and considering ways to treat both diseases and symptoms in order to limit the risk of activity restrictions.

The data nevertheless have some limitations. For example they do not provide an accurate diagnosis of diseases and health statuses. Ad hoc surveys are required when we need to extend our analysis to specific populations and identify specific factors. In this field, INED’s research also targets specific populations. While it does not focus on the loss of autonomy in the elderly, this work sheds light on situations and factors that increase the risks, by analysing functional problems and social statuses in order to evaluate the factors that pre-empt or hasten disability.

M. Espagnacq, N. Brouard and F. Meslé contributed to the Tetrafigap survey on the social status of people with spinal cord injuries. Ten years after the first survey, conducted in 1995, on social status (Association Francophone Internationale des Groupements d’Animation de la Paraplégie), they designed the new questionnaire for respondent and analysed their pathways. The Tetrafigap II study was one of the major pieces of research in this field at INED.

Gil Bellis, M. Cazes and A. Parant are also involved in designing the Family and Society Survey (enquête Famille et société) of people with cystic fibrosis and their families. Extending the research they conducted to create a register of people with CF, this survey aims to identify determinants of disability and factors that facilitate social participation.

Age, occupation, education and risk of dependency

The analysis of the processes of developing disability shows a progression in functional deterioration through different stages: common functional impairments (walking, hearing, eyesight, etc.), discomfort in performing activities, and the inability to perform basic tasks.

E. Cambois and J. Robine have found that increased age, a low level of education and the lowest-skilled occupational categories are criteria that increase the risks of functional impairment as a result of exposure to disease and accidents. These criteria also increase the risk of dependency among those with functional impairments. People’s status thus plays a role in their capacity to cope with functional impairments.

Is it possible to reduce the risk of dependency?

Mitigating disability and dependency depends both on preventing potentially incapacitating diseases and functional limitations and on helping people to compensate for functional limitations and limit their impact on activities.

The studies conducted at INED distinguish between functional limitations and activity restrictions in order to understand the factors that might prevent activity restrictions and more effectively assess the needs to be covered by society as the population ages. Better management of functional limitations is one way to reduce the risk of dependency.

We endeavour to identify social statuses or behaviours that enable some people more than others to compensate for their functional limitations and maintain a satisfactory level of activity.

Some references

Bellis Gil, Cazes Marie Hélène, Parant Alain, Gaimard Maryse, Travers Cécile, Le Roux Evelyne, Ravilly Sophie, Rault Gilles. 2007. Cystic fibrosis mortality trends in France. Journal of Cystic Fibrosis, 6, p. 179-186

Bellis Gil, Cazes Marie-Hélène, Lemonnier Lydie, Ravilly Sophie. 2010. Epidémiologie de la mucoviscidose en France : le rôle positif des CRCM. Le Concours Médical, 132 (15-16), p. 634-635

Cambois, E., J.-M. Robine, and I. Romieu, The influence of functional limitations and various demographic factors on self-reported activity restriction at older ages. Disability and Rehabilitation, 2005. 27(15): p. 871-883

Cambois, E. and A. Lièvre, Risques de perte d'autonomie et chances de récupération chez les personnes âgées de 55 ans ou plus : une évaluation à partir de l'enquête Handicaps, incapacité, dépendance. Etudes et résultats, 2004. 349: p. 1-11

Cambois, E. and J.-M. Robine, Problèmes fonctionnels et incapacités chez les plus de 55 ans : des différences marquées selon les professions et le milieu social. Etudes et résultats, 2004. 295: p. 1-8

Cambois, E. and J.-M. Robine, Vieillissement et restrictions d'activités : l'enjeu de la compensation des problèmes fonctionnels. Etudes et résultats, 2003. 261: p. 1-10

Crimmins Eileen M, Hayward Mark D, Hagedorn Aaron, Saito Yasuhiko, Brouard Nicolas. 2009. Change in disability-free life expectancy for Americans 70-years-old and older. Demography, 46 (3), p. 627-46

Espagnacq Maude. 2008. Mortalité à long terme et devenir social des blessés médullaires tétraplégiques. Etudes à partir des enquêtes Tétrafigap 1995 et 2006. Thèse de doctorat de démographie, Paris 1, Paris, 2 vol., 276+117 p