CARNETS DESCARTES

Caregivers: endangered species to be protected!

(Version Française)

Today, the sea (of caregivers) looks like abunding of fishes, but in coming decades, when the last waves of baby boomers get older and switch from caregivers to potentially disabled persons, who will look after them? The AARP's Public Policy Institute have just released a report suggesting that demographic trends (up to 2026) in the USA could have a major negative impact on the population of potential caregivers (report free of access). These projections are of concern, let's have a look on them, since they may apply more or less to our situation in Europe (where I am not aware of similar available studies).

In 2010, the "caregiver support ratio", i.e. ratio dividing the proportion of people aged 45 to 64 years old to those aged 80 or above, was 7.2. In 2030, it will drop to 4.1, and in 2050 below 3. Today, 14% of potential caregivers are themselves actually providing care to someone aged 80 or older (another fraction of people helps domeone younger than 80). So the sea seems currently full of fish, but what about tomorrow? In 2010, more than half of adults aged 80+ had a severe disability, and 30% needed help with bathing, using the toilet, dressing, cooking, and/or eating, i.e. substantial loss of autonomy. It is not easy to project trends on these proportions, since baby boomers have not yet reach 80 years old.

Lynn Feinberg, a senior strategic policy advisor at AARP, declared in the New York Times (dated August 26, free of access) : "What these numbers tell us is that relying on family and friends to provide long-term care may be unrealistic in the future", adding: "We need to be thinking about new approaches to financing and delivering long-term services and supports, particularly home and community-based services, which are what most people want.". In the mean time, Ms. Feinberg highlighted the need for "better supports for family caregivers", but did not endorse specific suggestions.

This projections contradict perception of US citizens on the topic, since 68% of Americans aged 40 and older are counting on their families to supply long-term care when and if it's needed, according to a poll conducted this year by Associated Press (access without any restriction). However, demographic trends seems heavily stable, with prolonged life expectancy, reduction of family size, more divorces among those age 50+, more people without children, and uncertainties regarding the impact of obesity epidemic on rates of disability in elderly people.

We need to have such projections available in France too, although I suspect dynamics of our demography is not so far from that in the USA.Other European countries may be in worse situation on this topic. Today, in France, there is a rough estimate of 1 million caregivers. Most of them are secluded, not directly truly helped by public policies, without any access to training programmes. For all these reasons, and also trying to protect and maintain these scarce invaluable resources which will not remain as abundant as today for a long time, I think we should offer them MOOCs, which are specifically dedicated to caregivers. That wil help keeping them motivate; that may contribute to fight their isolation by promoting social community networks, encouraged within these massive open online courses; eventually that would improve overall quality of care towards elderly and disabled people, among the most vulnerable segment of our population. We may envisage such a project through our MOOC platform which will be launched soon, this Fall, from the Centre Virchow-Villermé Paris-Berlin.

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Antoine Flahault's blog (in English)

Antoine Flahault's blog (in English)

Antoine Flahault's blog. He is Faculty member, in public health, from Descartes School of Medicine, Sorbonne Paris Cité

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