SIRVEN Nicolas

This systematic literature review documents the link between frailty or sarcopenia, conceptualized as dimensions of physical health, and the use of long-term care services by older individuals. Long-term care services include formal and informal care provided at home as well as in institutions. A systematic review was performed according to PRISMA requirements using the following databases: PubMed-Medline, Embase, CINAHL, Web of Science, and Academic Search Premier. We included all quantitative studies published in English between January 2000 and December 2018 focusing on individuals aged 50 or more, using a relevant measurement of sarcopenia or physical frailty and a long-term care related outcome. A quality assessment was carried out using the questionnaire established by the Good Practice Task Force Report of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Five subsets of long-term care outcome were considered: 1/ nursing home placement (NHP), 2/ nursing home short stay (NHSS), 3/ formal personal care (FPC), 4/ formal home help (FHH), 5/ informal care (IC). Out of 1943 studies, 17 were finally included in the review. With some studies covering several LTC outcomes, frailty and / or sarcopenia were associated with increased LTC use in 17 out of 26 cases (NHP: 5/6, NHSS: 3/4, FPC: 5/7, FHH: 1/4, IC: 3/5) The association was not consistent in 5 cases (NHP: 1/6, NHSS: 1/4, FPC: 2/7, FHH: 0/4, IC: 1/5) and the association was either not significant or the results inconclusive in the remaining 9 cases. Overall, while results on sarcopenia are scarce, evidence support a positive association between frailty and LTC use. The evidence is stronger for the association of physical frailty with nursing home placement / short stay as well as on FPC. There is less (more heterogeneous) evidence regarding the correlation between physical frailty and FHH or IC use. Results need to be confirmed by more advanced statistical methods or design based on longitudinal data.

Older adults regularly report rising levels of Subjective Well-Being (SWB) over time, despite a concomitant decline in their health. One possible explanation is that individuals develop psychological mechanisms to diminish the contribution of health to their well-being as they get older. This research examines whether observational data are consistent with this hypothesis of hedonic adaptation to health decline with ageing, in all aspects of SWB, and for different births cohorts over time. Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE) between 2007 and 2015 in 10 European countries for respondents aged 50 onwards (4 waves, 41,258 individuals), we estimated panel fixed-effects models for outcomes measuring the three aspects of SWB: evaluative (life satisfaction), experienced (positive and negative affectivity) and eudemonic well-being (sense of purpose and meaning in life). We decomposed age in birth cohort and time fixed effects. Changes over time in the contribution of health to SWB were estimated by interaction terms between health and time fixed effects. Results showed that the value of health changes over time and for different birth cohorts in ways that depend on the measure of SWB. Ageing increases the importance of health for both eudemonic and experienced well-being. By contrast, the association between health and life satisfaction weakens with age, except for individuals aged 80 and above for which it strengthens. Our results thus offer only little support for hedonic adaptation to health decline with age, restricted to life satisfaction and individuals under 80 years of age. These findings caution against the use of mean estimations over the lifespan to determine the value of health as well as against the use of the various forms of SWB interchangeably in public policy analysis and economic evaluations of healthcare.

The frailty phenotype in the elderly is defined as an increased vulnerability to stressors, leading to health problems. It is recognized as identifying the risk of disability at an early and reversible stage. Although the literature on the socioeconomic determinants of frailty emerges in cross-sections, little was known about the dynamics of this relationship over time. Our paper examines the joint evolution of frailty and changing economic conditions for people aged 65 and over in Europe, and this presentation, shows that the SHARE survey is an interesting tool to analyze these issues requiring a time horizon: because of the richness of the data especially on health and economic issues.

Objectives: This study examines prescribers’ compliance with the 2011 clinical recommendation of the French National Authority for Health (HAS) aiming to limit the use of drugs specific to Alzheimer’s Disease (AD), and whether prescribers’ compliance differs as a function of patient gender. Study design: The sample consisted of quarterly data from the National Health Insurance claims database from 2010 to 2013 (16 quarters) for individuals living in the community, aged 65 or over at baseline. Methods: The probability of consuming AD drugs was estimated using a fixed effects model to account for individual and unobserved heterogeneity. Time-varying covariates were included to control for changes in health status and insurance effects. Estimations were carried out for men and women separately. Results: Discrepancies in trend of the probability of consuming AD drugs between women and men after the HAS’ 2011 recommendation were observed: the probability decreased for women while it remained constant for men. Conclusions: Our case study complements the literature on the influence of clinical recommendations by HTA body on clinical practices. Public health policies should take into account sex and gender differences in the management of AD patients. Further research should investigate how to implement gender targeted therapies and prevention, and their effects.

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This paper explains the observed hospital congestion in developing countries as the result of the interaction between ambulatory care physicians who refer patients to hospitals, and hospitals which must detect the severity of the incoming patients’disease. In an imperfect information environment, physicians might refer to top-tier hospitals patients with mild diseases that could be properly addressed by regular hospitals, just to ful…ll patients’demand for the best care. Yet, the triage capability of top-tier hospitals declines if the hospital is subject to congestion, which, in turn, provides incentives to physicians to refer more patients to these hospitals. The model presents two equilibria, one with perfect triage, and another with triage errors and hospital congestion. In this last equilibrium, a higher hospital size raises the likelihood of congestion.

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In 2014, the Cnav's Social Action Department decided to acquire a new frailty detection tool to improve the targeting of people at risk of loss of autonomy and to offer them prevention programs better adapted to their needs. This new frailty detection tool, called the Fragire grid, was developed by the Burgundy Franche-Comté interregional gerontology cluster (PGI) based on a clinical cohort. In this study, we want to evaluate to what extent the Fragire score is 1) reproducible in a general population, 2) able to identify frail elderly people using Fried's phenotype as a reference indicator, and 3) predictive of the onset of loss of autonomy (appearance of restrictions in activities of daily living and development of personal assistance). We use panel data from the Share survey (European survey on health, ageing and retirement among people aged 50 and over), representative of the population in ordinary households in metropolitan France, between 2004 and 2010. These data allow us to reconstruct the Fragire grid algorithm according to the methodology developed by the AIP, and to measure the association of the Fragire score with different variables related to loss of autonomy at two and four year intervals. Our results indicate that, without being perfect, this score allows the detection of frail people. It also makes it possible to anticipate the use of assistance and future disabilities. These results underline the importance of this new frailty indicator for developing effective prevention policies to target individuals at risk of loss of autonomy.

The management of dementia is a challenge for clinicians because these patients constitute a heterogeneous population. In the context of this management, the interest of antidementia drugs (anticholinesterase and memantine) is debated: the clinical effectiveness seems questionable and the adverse effects are not negligible. In 2010, good practice recommendations gave physicians the choice to prescribe or not these drugs. Since then, questions remain unanswered: 1/ what is the evolution of the prescription rates of these drugs since these recommendations, in other words how has the clinical expertise of physicians, one of the pillars of the evidence-based medicine triptych, been expressed? 2/ what are the factors that remain associated today with the fact of prescribing or not prescribing these drugs? and 3/ is there an over-hospitalization linked to their adverse effects? The question of over-medicalization is at the heart of our thesis problem. In this work, we answered these 3 questions which constituted our 3 objectives. We were able to show that physicians seemed to be less and less confident about antidementia drugs with a decrease in their prescription since 2010 and important consequences in terms of avoided costs. When they continued to be prescribed, these treatments were mainly prescribed for younger patients or those in better health. Finally, anticholinesterase drugs, mainly rivastigmine, increased the risk of hospitalization through cardiac and digestive adverse effects. Our results argue against the prescription of antidementia drugs from the point of view of both morbidity and health care costs. The question of the patient's point of view remains.

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PURPOSE: This study analyses the relationship between medication use and frailty by considering the quantity of medications prescribed (polypharmacy) and the quality of medication prescribing (according to French criteria for Potentially Inappropriate Medications-PIMs) in people aged 65 and over. METHODS: This is a cross-sectional study based on the data from a nationally representative study about health and use of healthcare resources in France (ESPS 2012). The number of frailty criteria was assessed among exhaustion, unintentional weight loss, muscle weakness, impaired mobility, and low level of physical activity. Polypharmacy and PIMs were assessed from the data of reimbursement by the National Health Insurance over the whole year 2012. PIMs were defined according to the Laroche list plus additional criteria dealing with inappropriate prolonged use of medications. The analyses used Poisson regression models, with the number of frailty criteria as dependent variable. RESULTS: The study population was composed of 1003 women and 887 men, of mean age 74.7 +/- 7.4 years. Polypharmacy (5 to 9 drugs) and excessive polypharmacy (≥10 drugs) were reported in 42.9 and 27.4% of the study population, respectively, while 46.7% of the study population received at least one PIM during the year 2012. Polypharmacy and PIMs were both associated with the number of frailty criteria in models adjusted for socio-demographic and health characteristics of the participants. The prescription of anticholinergic medications was the only PIM that remained significantly associated with the number of frailty criteria after adjustment for polypharmacy. CONCLUSIONS: Polypharmacy and use of anticholinergic medications are independently associated with frailty in old people.

The objective of the present work is to explore the incremental costs of frailty associated with ambulatory health care expenditures (HCE) among the French population of community-dwellers aged 65 or more in 2012. We make use of a unique dataset that combines nationally representative health survey with respondents’ National Health Insurance data on ambulatory care expenditures. Several econometric specifications of generalized linear models are tested and an exponential model with gamma errors is eventually retained. Because frailty is a distinct health condition, its contribution to HCE was assessed in comparison with other health covariates (including chronic diseases and functional limitations, time-to-death, and a multidimensional composite health index). Results indicate that whatever health covariates are considered, frailty provides significant additional explanative power to the models. Frailty is an important omitted variable in HCE models. It depicts a progressive condition, which has an incremental effect on ambulatory health expenditures of roughly €750 additional euros for pre-frail individuals and €1500 for frail individuals.

Objective: Hospital services use, which is a major driver of total health expenditures, is expected to rise over the next decades in Europe, especially because of population aging. The purpose of this article is to better understand the dynamics of older people's demand for hospital care over time in a cross-country setting. Data source: We used data from the Survey on Health, Ageing, and Retirement in Europe (SHARE), in 10 countries between 2004 and 2011. Study design: We estimated a dynamic panel model of hospital admission for respondents aged 50 years or more. Principal findings: Following prior research, we found evidence of state dependence in hospital use over time. We also found that rise in frailty-among other health covariates-is a strong predictor of increased hospital use. Progression by one point on the frailty scale [0.5] is associated with an additional risk of about 2.

The issue of fuel poverty is of growing interest in the economic, political and social spheres. This thesis in economics focuses on the representation and analysis of the interactions of three fundamental items in the constrained expenses of households, namely health, housing, and energy, in order to reveal relevant levers for the implementation of actions to combat fuel poverty. This paper proposes an original theoretical and analytical analysis, by approaching this phenomenon in terms of equity, thus highlighting the existence of inequalities and justifying the implementation of complementary, or even new, measures in favor of greater equity between individuals with regard to the energy good. On the other hand, characterizing the dynamics of this phenomenon provides valuable information on the type of measures (i.e., bill payment assistance, innovative bill payment methods, housing renovation assistance) that can be put in place to counteract this phenomenon, and thus participate in the pursuit of the underlying equity objectives. Secondly, the analysis of the consequences of fuel poverty on other dimensions than those referring to energy (i.e., health) allows policy makers to question its multidimensional and porous aspect with other dimensions of social precariousness. This phenomenon is a vector contributing to the aggravation of other inequalities (i.e., health inequalities), which can thus compromise the pursuit of the equity objective of public decision-makers. Finally, the study of new and innovative means of payment for the energy good (i.e., prepayment), at lower costs, allows us to identify prepayment as a tool that can contribute to the achievement of the objectives of horizontal and vertical equity respectively.

The concept of frailty as a health dimension in old age is recent and has its origin in the development of geriatric medicine. Initially an unformulated clinical intuition, it is now defined by a diminished physiological reserve of multiple organs that exposes older individuals to increased vulnerability to stressors and a higher risk of adverse outcomes. The operational definition of frailty, however, is still debated. From a diversity of models, two emerged in the early 2000s from epidemiological studies conducted in large population-based aging cohorts. The body of research emphasized prospective associations between a frailty phenotype and a range of adverse outcomes or between a frailty index measuring the accumulation of deficits and death. A few studies showed promising spontaneous remissions in the early stages of frailty, raising expectations for effective interventions. Transitions between frailty stages and effective interventions on frailty nevertheless remain two fields needing further investigation. More recently, these tools have been applied as screening instruments in clinical settings to guide individual decision-making and orient treatments. New questions are raised by the use of instruments developed to screen frailty in epidemiological research for assessing individual situations. Inquiring whether frailty screening is relevant opens a Pandora's box of doubts and debates. There are many reasons to screen for frailty both from a public health and a clinical perspective that are only exacerbated by the current demographic evolution. Open questions remain about the feasibility of frailty screening, the properties of screening tools, the relevance of an integration of socioeconomic dimensions into screening tools, and the effectiveness of interventions targeting frailty. Fifteen years after the publication of the Fried and Rockwood landmark papers proposing operational definitions of frailty, this article presents an overview of current perspectives and issues around frailty screening in populations and in individuals.

‘Active Ageing’ strategies aim to foster the participation of seniors in the society. Although economic literature has extensively studied the incentives for seniors to increase their labour supply, little is known about the motivations for older people to complement labour with other forms of social participation. This article provides empirical evidence of the role of intrinsic and extrinsic rewards received at work in the supply of formal and informal productive activities of 50- to 65-year-old workers. The results show that workers with higher levels of intrinsic rewards received at work, such as skill development opportunities and decision latitude, are more likely to participate in social activities outside the labour market. Extrinsic rewards on the other hand, like advancement perspectives, job security and pay, appear independent from both formal and informal social participation.

We estimate a reduced form model of expectations-based reference-dependent preferences to explain job retention of older workers in Europe in the context of the 2009 economic crisis. Using individual micro-economic longitudinal data from SHARE (The Survey of ealth, Ageing, and Retirement in Europe) between 2006 and 2011, we derive a measure of “good, bad or no surprise” from (i) workers’ anticipated evolution of their standard of living five years from 2006 (reference point), and from (ii) a comparison of their capacity to make-ends-meet between 2006 and 2011. We find that the probability to remain on the labour market in 2011 is significantly higher for individuals who experienced a lower than expected standard of living. The effect of a “bad surprise” on job retention is larger than the effect of a “good surprise” once netted out from the effects of expectations at baseline, change in consumption utility, and the usual lifecycle determinants on job retention of older workers. We interpret this result as an evidence of loss aversion in the case the reference point is based on individuals’ expectations. We also find that loss aversion is more common among men, risk-averse individuals and those with a higher perceived life expectancy.

Debt bondage is the focus of an international struggle for its abolition. Yet the literature finds that, in certain circumstances, the credit-for-work contracts behind debt bondage are mutually beneficial to both employer and employee. We take on an empirical study in south India to assess whether choosing credit, which can raise a risk of dependence on the lender and therefore a risk of debt bondage, is a choice made to prevent other forms of risk, especially financial risk and the risk of violence. We find this to be the case in our study. From a policy point of view, the abolition of debt bondage in these circumstances could drive up the very same forms of risk against which households seek to guard. In this context, providing alternatives employment solutions to rural workers is a priority. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

The coincidence between trends in the decline of workers’ health and the increasing practice of Corporate Social Responsibility (CSR) seems a paradox. Using data from the French Employment Survey 2005, in this article the authors develop an index of responsible prevention by combining a score of severity of working conditions with a score of risk prevention at the workplace. The authors then explore the influence of this variable on the propensity to stop working for medical reasons. The results show that prevention increases workers’ health status and suggest the existence of an optimal level of social CSR expenditure.

Support for the presentation by T.Rapp at the Handicap et Dépendance seminar on March 12, 2015. The purpose of the paper presented here is to evaluate the effect of French public subsidies financing the use of home help (Allocation personnalisée d'autonomie, APA) on the health of dependent elderly people (measured by the rate of emergency room visits). An instrumental variable model is implemented on the sample obtained by the Plasa randomized experiment (Plan of care and assistance in Alzheimer's disease, conducted between 2003 and 2007 at the Toulouse University Hospital). The results show a significant negative effect of the APA on the hospitalization rate.

Elderly people facing dependence are exposed to the financial risk of long lasting care expenditures. This risk is high for people facing cognitive, functional and behavioral problems. In the short-term, dependent elderly people face increased non-medical care expenditures. In the long-term, they face increased medical care expenditures, which are driven by emergency care events such as: emergency hospitalization, emergency medical visits, and emergency institutionalizations. In France, providing public financial assistance has been shown to improve dependent people's access to non-medical care services. However, the impact of public financial assistance on emergency care use has not been explored yet. Our study aims at determining whether financial assistance on non-medical care provision decreases the probability of emergency care rates using data of 1131 French patients diagnosed with Alzheimer's disease, collected between 2003 and 2007. Using instrumental variables to deal with the presence of a potential endogeneity bias, we find that beneficiaries of long-term care subsidies have a significantly lower rate of emergency care than non-beneficiaries. Failing to control for endogeneity problems would lead to misestimate the impact of long-term care subsidies on emergency care rates. Finding that home care subsidies has a protective effect for emergency care confirmed the efficacy of this public policy tool.

This dissertation studies the aid policies for dependent elderly people at home in Japan, in order to draw lessons for France. We develop our study through three axes: i) the analysis of the differences between the Japanese and French systems in the organization of public aid and in the aid actually perceived by the persons in loss of autonomy, ii) the examination of the potential barriers to the access to public aid in Japan, iii) the study of the consequences of informal aid on the employment of senior women in Japan In this perspective, we conducted two qualitative studies comparing Japanese and French policies, followed by two micro-econometric studies of individual and family caregiving behavior in the Japanese context. This work thus highlights the specificities of the policies implemented in the two countries, and underlines the advantages and weaknesses of the Japanese model.

This chapter considers the nature of the association between social participation and self-perceived health among older European adults. We examined the effect of the various combinations of participation in voluntary activities on older people’s self-rated health using SHARE data over the period 2004–2011 for 18 European countries and Israel. We found, on the whole, that taking part in social activities within the framework of voluntary organisations was indeed associated with a lower relative risk of reporting having had fair to poor health. At the same time, however, we found that participation in different forms of activities yielded unequal relationships with the health outcome. That is, not every activity or combination of activities contributed to health to the same degree. Exploring the drivers of heterogeneity in the relationship between health and volunteering in more depth, we found that the more activities older people get involved in, the better it is for their health, regardless of the types of activity.

Although a wide range of studies have tackled the outputs of social capital, fewer efforts have so far been dedicated to unveil its inputs. This study provides new empirical evidence on the determinants of social capital. The assumption to be tested is that the influence of “length of residence” on migrant’s social capital is different across host countries in Europe. The study makes use of data from the wave 2 of Survey of Health, Ageing, and Retirement in Europe (2006–2007) on individuals aged 50 or more in 14 European countries. Social capital is measured through two binary variables of participation in social activities and high generalized trust.

Since the mid-1990s, the notion of social capital seems to have enjoyed a certain popularity in the economic literature. Originally, it was a concept developed by the sociologist P. Bourdieu, but very quickly the concept of social capital expanded to refer to all social interactions within a society. One of the consequences of this drift was to consider that institutions are a form of capital, which led to a renewed interest in endogenous growth models. Among the many limitations of this approach, the main problem lies in the abundance and imprecision of definitions of social capital, so that it appears to be a catch-all concept. In order to overcome this difficulty, this study proposes to reinterpret Bourdieu's definition from a microeconomic perspective. Thus, social capital is defined as the set of rights that an individual has over the resources of his or her social network. This definition makes social capital an asset that households can use in case of need.