With the extension of life expectancy, new questions emerge as to the quality of this prolonged life. While we could expect longevity to be synonymous with better quality of life, we have conducted several research, by relying on a European database, which demonstrate a much more complex and contrasting reality.
We have studied parameters that impact quality of life when we advance in age, such as socioeconomic inequalities and variability in the quality of care that is provided in retirement homes in Europe. We also became interested in the perception that the elderly could have of their place of life, which they reside in their home or in a retirement home.
A combination of inequalities for the poorest
In a research published in the French Review of Economywe focus on the impact of socioeconomic status on loss of autonomy at an advanced age. This study reveals deep and persistent disparities between socioeconomic groups, to the detriment of people from disadvantaged socio -economic backgrounds.
One of the key discoveries of this research is the existence of a “triple pain” for the poorest individuals.
First, these people suffer from a shorter life expectancy (depending on the country, the gap can range from 4 to 7 years of life expectancy). In addition, they spend more time in a state of dependence and, finally, they encounter more difficulties at the end of life (like being able to dress, wash or get eaten alone).
This combination of inequality is particularly worrying. It indeed means that people from disadvantaged backgrounds live not only for less long, but also that their quality of life at the end of the course is significantly degraded compared to those of easier socioeconomic groups.
Note that in our research work, we used data from a large longitudinal survey: “Survey of Health, Ageing and Retry in Europe” (Share). These data make it possible to analyze the health trajectories of individuals over time, which is crucial to understand the evolution of loss of autonomy.
Living at home or in a retirement home: what perception of the elderly?
While we note that access to rest houses differs according to the heritage of those questioned (the richest people would be those who avoid the retirement home more), we study the impact of this place of life on their well-being.
Indeed, in another very recent study, we explore the preferences of the elderly about their place of life. The desire to age “at home” is often expressed by seniors who perceive the retirement home as an option of last resort. However, this study reveals a more nuanced reality. By analyzing the data from the Share survey, we compared the subjective well-being of people living at home to that of residents of retirement homes.
Initially, the results show that people living in a retirement home report a level of life satisfaction below those living at home, with a difference of almost 8 %. This disparity seems to strengthen the idea that the retirement home is negatively linked to the well-being of the elderly.
However, after having controlled by the variables linked to health, functional status (being able to wash, dress or eat alone) and demographic characteristics such as age, sex or even levels of education and wealth, the difference in well-being between the two groups becomes negligible.
But beware, when you use pairing methods, comparing similar people in each of the two habitats, being in a retirement or care home seems to have a negative impact on happiness.
Ehpad or home: choose the best option according to your health
Conversely, as we were able to follow individuals over time and especially for those observed several times, we found that they were experimenting with added value after entering the retirement and care home.
In other words, people who find themselves in a retirement home are not necessarily less happy because of their place of residence, but rather because of their often more precarious state of health.
This questions certain received ideas on retirement homes. Although they are often perceived as unwanted places, retirement homes offer, for some individuals, an environment more suited to their health needs. For example, a person losing mobility or needing continuous assistance for daily activities can benefit from the institutional framework of these establishments, where appropriate care is permanently available.
The results therefore suggest that, for many seniors, the choice to live in a retirement home is often the best option according to their state of health. Rather than considering the retirement home as a failure or a constraint, it is important to recognize that these establishments can improve the quality of life of those who require significant medical support.
Note that, in our work, we do not approach the question of mistreatment in nursing homes that have been able to do the news in recent years, especially in France, nor those who can also occur when a person in the old age lies at their home.
Finally, the difficulties of accessing retirement homes for all, given their costs which can be prohibitive, are also parameters that can weigh.
Excess mortality in retirement homes in northern Europe, even before the COVVI-19
In another study, we examine the mortality of residents in retirement homes before the Pandemic of COVID-19 which exacerbated the existing problems in these institutions. This research is interested in mortality differences between residents of retirement homes and people living at home in different European countries.
The results reveal significant excess mortality in retirement homes in northern European, center and East countries, compared to those in southern Europe such as Italy and Spain. For France in particular, but with a relatively small sample, the effect was not present.
These differences in mortality are partly explained by differences in the quality of care and the organization of retirement homes. In northern European countries, retirement homes are often large establishments, managed by for -profit structures. This can influence the quality of care provided, the resources being sometimes insufficient to meet the growing needs of residents. On the other hand, in the countries of the South, where care is more personalized and where family structures play a more important role, mortality is not as pronounced.
The study also highlights the need for structural reforms to improve living conditions in retirement homes. An increase in resources allocated to long-term care, stricter quality standards and better support for caregivers could help reduce this excess mortality and improve residents' well-being.
Grandparents more supported in the event of dependence
So far, we have mainly mentioned formal aid, whether they have held in institutions or at home. However, it is important to recall that the main provider of help for dependent people is the family.
In recent research, we are examining a new motif behind the “guard” of grandchildren: reciprocity in the event of dependence.
We design a model at two periods, that is to say a first period, when the grandparent is in good health and capable of taking care of his grandchildren, and a second, where he is in a situation of loss of autonomy, to analyze the anticipation of this reciprocity by the grandparents.
Using data from the Share longitudinal survey, we confirm the idea that the grandparents who kept their grandchildren when they were in good health receive more aid when their health deteriorates. And the intensity of this grandparent support for their children is important! The more they help, the more they receive support from their children whose offspring they keep if necessary.
Reduce socio -economic inequalities and in the quality of care
The results of all of our studies clearly show that care for the elderly, whether provided at home or in a retirement home, require special attention from political decision -makers. Socioeconomic inequalities and variations in the quality of care between European countries or even public or private structures create significant and damaging disparities in the end -of -life conditions of seniors.
It is crucial that public policies attack these inequalities by improving access to care, strengthening social security nets and supporting family structures that play a key role in many countries.
In addition, reforms in retirement homes are necessary to ensure that all residents, regardless of their place of life, have access to quality care. The stakes are high: while the European population continues to age, guaranteeing a worthy and quality end of life for all becomes an essential social and political priority.
