Ageing and society: pathways and new models

The speakers first recalled the extent of demographic change. Life expectancy has risen sharply for several decades, with a slowdown observed since the 2010s – and it is impossible to determine a definitive ceiling. At the same time, increasing numbers of centenarians provide a concrete illustration of the acceleration of ageing: there are about 40,000 today, a number forecast to rise to almost half a million by 2100.

This growth questions the balance of our society and calls for clear public choices: how should we allocate our focus across different life stages, should we build nurseries or nursing homes, and how can we come up with solutions that meet increasingly demanding expectations in terms of freedom, quality and personalisation?

 Professor Thomas Rapp pointed out that focusing on expectations can result in “missing the mark”. Initial results from international studies show that a larger proportion than expected of French people are not, in principle, against living in care facilities and could consider a change of living space – such as a residence or facility – to be the best option for their quality of life under certain conditions. The discussion also highlights the role of words, representations and lived experience: the focus is not just on a particular “place”, but on life plans, the quality of care, teams’ attentiveness, the environment and dignity.

Professor Sylvie Bonin-Guillaume emphasised the exhaustion of caregivers, who are often invisible, and the need to better identify them, support them and prevent them from burning out – something that also makes care recipients’ journeys more challenging. She reiterated that home care is based on several complementary components – the medical side (reimbursed by the health insurance system) and the medico-social and social side (independent living aids, home help) – and that coordinating professionals and their availability are both major challenges.

Ageing in itself is not the main cost driver – it is the loss of independence and especially the last months of life, which often involve highly hospital-centred care, that generates the highest costs. As the baby boomers’ “demographic wall” approaches, the question becomes a collective one: are we prepared to absorb a spike in spending while improving people’s quality of life? For the speakers, this means shifting focus towards more prevention, better coordinated pathways and credible alternatives to hospitalisation, in line with people’s widely expressed desire to avoid dying in hospital.

Making comparisons with other European countries sheds light on these choices. France, alongside Spain and Italy, is among the countries with the highest life expectancy. But when we look at disability-free life expectancy, its performance is more mediocre, while the Nordic countries and Switzerland score significantly higher. This difference highlights public policies that are more focused on preventing loss of independence, intervening at an earlier stage and improving coordination between the medical, medico-social and social aspects.