Skip to content

Institute of Public Policies

Home » Projects » Health and autonomy » The care pathways of older people with declining independence and regional disparities in care provision

The care pathways of older people with declining independence and regional disparities in care provision

Project Status Completed

Context

The ‘CARE’ survey programme, produced by the Drees (Directorate for Research, Studies, Evaluation and Statistics), has helped to improve understanding, at national level, of the situation of older people with reduced independence and their carers. However, two aspects remain largely unexplored: changes in care needs over time, and regional inequalities. The situation of family carers, who are on the front line of care provision, is also still poorly understood.

The research programme ‘Trajectories of older people with reduced independence and departmental disparities in care provision’, supported by the CNSA, aims to gain a better understanding of these three aspects. There is also a forward-looking dimension, as the results will be used to feed into the TAXIPP-LIFE model to produce medium- and long-term projections of the number of dependent older people and their family circumstances (presence of potential carers).

Since 2015, the IPP has developed expertise on the subject of older people within the framework of the PSE Chair in Dependency. This expertise has been built around two projects: the European ‘Longlives’ project, and the development of a ‘care dependency’ module based on the TAXIPP-LIFE dynamic microsimulation model. The programme ‘Trajectories of older people experiencing a loss of independence and departmental disparities in care provision’ builds on these projects.

Presentation

The aim is to inform public policy in the field of long-term care by exploring three dimensions: the pathways of older people requiring long-term care (transition to residential care, mortality), the characteristics of informal carers, and geographical disparities in long-term care needs and the provision of such care.

The programme is based on the analysis of data from the ‘Care’ survey programme, carried out by the DREES between 2014 and 2016 with the support of the CNSA, and is structured around five areas of focus:

  • Axis 1 (2020–2021): For different conditions, what are the socio-economic determinants, protective environments and the effect of the APA on the probability of death?
  • Axis 2 (2021–2022): The future outcomes of APA recipients based on their past trajectories and the probability of moving into a care home
  • Axis 3 (2020–2021): Support for dependent older people: how is the carer population likely to change?
  • Research Area 4 (2020–2021): How can we explain the geographical disparities in the prevalence of dependency?
  • Priority Area 5 (2021–2022): Social welfare policies for older people: what are the differences between regions?

Each research area comprises three levels of data analysis:

  • A first, descriptive level: this involves publishing previously unpublished results from the Care-Ménage, Care-Institutions and Care-Aidants surveys, supplemented by their matched data sets. This initial level of analysis will build on the results already published by the DREES.
  • A second level, focusing on the analysis of public policies, and the APA in particular: the aim will be to assess the protective role of the APA in the home and other environmental factors. The aim is also to gain a better understanding of the various forms of care for dependency across the country, both in terms of variations in informal support and the implementation of local policies to support those experiencing a loss of independence.
  • A third level uses the results of the first two to enhance the TAXIPP-LIFE model developed by the IPP, transforming it into a microsimulation model that combines demographic, epidemiological and economic dimensions in a novel way.

Research Team

This project is led by the pole Health and autonomy.
Delphine Roy
Delphine Roy
Mahdi Ben Jelloul
Mahdi Ben Jelloul
Amélie Carrère
Amélie Carrère
Elsa Perdrix
Elsa Perdrix
Audrey Rain
Audrey Rain
Léa Toulemon
Léa Toulemon
Antoine Bozio
Antoine Bozio

Method and Data

Taxipp-life

Legal notices relating to the CARE survey: Pursuant to Law No. 51-711 of 7 June 1951, as amended, responses to this survey are mandatory and are protected by statistical confidentiality.

In order to reduce the time taken to complete the survey, and in accordance with Decree No. 2015-343 of 26 March 2015 establishing an automated processing system for personal data known as ‘Capacities, Support and Resources for Older People (CARE)’, the information collected as part of this survey has been supplemented by administrative data on healthcare usage in the community and in hospitals available from the National Health Insurance Fund (CNAM), on financial resources (data from tax sources) including social security benefits (CNAF, CCMSA and CNAV) and on civil status (data from INSEE’s National Register of Natural Persons). Like the survey responses, this data has been treated as strictly confidential.

In accordance with the General Data Protection Regulation, respondents may exercise their right of access to and rectification of their personal data by writing to the following address: drees-rgpd@sante.gouv.fr.

Partners

Caisse nationale de solidarité pour l’autonomie (CNSA)Direction de la recherche des études de l’évaluation et des statistiques (Drees)

In line with its remit to support research, the CNSA (National Solidarity Fund for Independence) is funding this research contract, which aims to pool resources to enable the IPP to continue its work on the topic of loss of independence, whilst contributing to an in-depth statistical analysis of the data from the CARE survey, which it has also funded. The aim is to gain a better understanding of the causes of regional variations in the APA coverage rate, taking health data into account, with a view to the continuous improvement of public policies.

This research programme is being carried out in collaboration with the DREES (Directorate for Research, Studies, Evaluation and Statistics of the Ministry of Solidarity and Health).

Last modified: July 20, 2026