title: [Tomorrow, who will take care of the elderly? The oldest old support ratio].
abstract: The 1998 report on Aging by the French National Ethical Advisory Committee stated that: "human life expectancy is increasing at its fastest rate in history". Professor Denys Pellerin, one of the rapporteurs, stressed the problems this would pose in coming years. More than 10 years later, these forecasts have been confirmed and new emerging problems call for further reflection. In particular, the place of informal caregivers needs to be reevaluated. This article examines informal caregivers' involvement in the care of the oldest-old and dependent adults in France, and the implications of the ongoing reduction in their numbers. Intergenerational links are examined, along with differences between chronological and functional age, chronic health impairments and disabilities in daily living. The large number of people over 75 years of age, and their difficult living conditions, underline the importance of informal caregivers. In France, in the 1950s, the oldest-old support ratio (OOSR) between persons aged 50 to 75 years and persons over 85 years was 45 to 1. In 2050 the OOSR is likely to be closer to 5 to 1! This trend will have important consequences for home care, which is widely considered to be the best way of preserving human dignity, as underlined by Professor Maurice Tubiana in a 2005 report on "Social insertion of the elderly at home ". While homecare is the most economic form of care, it also appears to be the most difficult to maintain and develop. Possible solutions include:--Better integration of old age within the human life cycle--Recognizing and supporting informal caregivers' excellent work--Maintaining adequate numbers of community-based healthcare professionals--Providing caregivers and healthcare professionals with specific training--Developing new and financially attractive care programs.
authors.affiliation: Gériatrie, Hôpitaux universitaires de Genève-Suisse, 40A route de Malagou 1208 Genève-Suisse. jean-pierre.michel@hcuge.ch
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Michel
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Robine
authors.forename: François
authors.initials: F
authors.lastname: Herrmann
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017028:Caregivers; D005260:Female; D005544:Forecasting; D005602:France; D006299:Health Services for the Aged / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D008297:Male; D012944:Social Support