Elderly in France are excluded and ‘ghettoised’

The "ghettoisation" of the elderly in France is the result of ageism, collective denial and inadequate and disrespectful policies, according to a 68-page report published by the governmental National Consultant Committee on Ethics (CCNE).

The report, titled The Ethical Stakes of Ageing, asks: "What does it mean to concentrate the elderly among themselves, often against their will, in permanent residences until the end of their lives?"

Nine per cent of the French population, or 6.1 million people, are over 75 years of age. Nearly 600,000 elderly people live in 7,200 retirement homes known as EHPADs, établissements d'hébergement pour personnes âgées dépendantes.

The average cost of living in an EHPAD is €1,949 per month, “the equivalent of 114 per cent of the average monthly income of a retired person”, the report notes. Institutionalisation of the elderly may be based on good intentions, “but the frequent absence of alternatives and being forced to pay for something they do not want is contrary to ethics and respect for these persons”.

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By 2050, 28.5 per cent of the total population of the EU will be over the age of 65, according to Eurostat. "Europe is ageing rapidly because of longer life expectancy and falling birth rates," the demographer Laurent Chalard told Le Monde. Without immigration, the European population could decline 16 per cent by 2060.

“The consequences of longevity have not been recognised as one of the major problems of our society in coming decades,” say the 10 doctors, lawyers, scientists and philosophers  who spent a year and a half on the CCNE report. “It is better for our society to have the courage to pose these questions now.”

Explore alternatives

The authors appeal to policymakers to explore alternatives, such as integrating EPHADs in apartment buildings to create “inter-generational habitats” or promoting self-management of residences by the elderly themselves. Unless more help is given to family members who look after elderly relatives, and unless care-givers are given better pay and training, the best solution of helping the elderly to stay in their own homes will not be an option.

Old age has become something shameful in western societies, the authors write. “By consequence, it is hidden from the public. Millons of elderly people are ignored in social discourse and by the media.”

The obsession with youth and a “shared, modern fear of ageing” have transformed attitudes. Old age was once seen as a sign of wisdom and detachment. In the 20th century, the prestige of old age “diminished a great deal because the notion of experience was discredited”, the report says, quoting the philosopher Simone de Beauvoir.

"Today's technocratic society does not believe that knowledge increases with age, but that it becomes outdated," de Beauvoir wrote in her 1970 book La vieillesse. "Age has become a disqualification."

Nearly a third of respondents to a survey by the IPSOS-Senior Association said their second greatest fear, after physical deterioration, was “social isolation and the loss of dear ones”.

The segregation which results from ageism is compared to that based on racism. "The apartheid of age is all the more fierce because it is unconscious, including among the victims," the psychiatrist Jean Maisondieu writes.

The effect on the elderly is devastating, with 40 per cent of residents in retirement homes suffering from depression. France has the highest suicide rate in Europe for people over the age of 75.

No network

A report by the Fondation de France states that a quarter of people over the age of 75 live alone. Half those in the same age group no longer have a network of friends, while 52 per cent have no contact with neighbours and 41 per cent are ignored by their children.

The fact that sensory and cognitive functions slow down among the elderly aggravates their isolation. “When a care-giver asks a resident of an EHPAD a question, it’s not unusual for the person to reply after the care-giver has finished washing him or her and left the room,” the report notes.

Because older persons can be slow at undressing, doctors often “examine” them with their clothes on, which sometimes prevent them discovering serious illnesses such as cancer.

The problem is particularly acute in emergency rooms, where rushed personnel don’t have time to listen to an elderly patient’s laboured explanation. As a result, “the aged patient, whose suffering is not considered an immediate emergency, is set aside, leading to a long wait on a trolley”.

Only on Friday, France Bleu Touraine radio station reported that two 90-year-old women died in the emergency room in Tours in April and May. One had spent six hours on a trolley, the other four.

“What shocked us is that we, as care-givers, were unable to accompany them when they died surrounded by other patients in a packed waiting room,” an emergency room employee said.