Nicolas Sirven

Social capital and health of older Europeans: Causal pathways and health inequalities

This study uses a time-based approach to examine the causal relationship (Granger-like) between health and social capital for older people in Europe. We use panel data from waves 1 and 2 of SHARE (the Survey of Health, Ageing, and Retirement in Europe) for the analysis. Additional wave 3 data on retrospective life histories (SHARELIFE) are used to model the initial conditions in the model. For each of the first 2 waves, a dummy variable for involvement in social activities (voluntary associations, church, social clubs, etc.) is used as a proxy for social capital as involvement in Putnamesque associations; and seven health dichotomous variables are retained, covering a wide range of physical and mental health measures. A bivariate recursive Probit model is used to simultaneously investigate (i) the influence of baseline social capital on current health - controlling for baseline health and other current covariates, and (ii) the impact of baseline health on current participation in social activities - controlling for baseline social capital and other current covariates. As expected, we account for a reversed causal effect: individual social capital has a causal beneficial impact on health and vice-versa. However, the effect of health on social capital appears to be significantly higher than the social capital effect on health. These results indicate that the sub-population reaching 50 years old in good health has a higher propensity to take part in social activities and to benefit from it. Conversely, the other part of the population in poor health at 50, may see their health worsening faster because of the missing beneficial effect of social capital. Social capital may therefore be a potential vector of health inequalities for the older population.

The cost of frailty in France

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 isxa0an 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.

Frailty, polypharmacy, and potentially inappropriate medications in old people: findings in a representative sample of the French population

PurposeThis 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.MethodsThis 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.ResultsThe study population was composed of 1003 women and 887 men, of mean age 74.7 +/− 7.4xa0years. 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.ConclusionsPolypharmacy and use of anticholinergic medications are independently associated with frailty in old people.

The Dynamics of Hospital Use among Older People Evidence for Europe Using SHARE Data

OBJECTIVEnHospital 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 peoples demand for hospital care over time in a cross-country setting.nnnDATA SOURCEnWe used data from the Survey on Health, Ageing, and Retirement in Europe (SHARE), in 10 countries between 2004 and 2011.nnnSTUDY DESIGNnWe estimated a dynamic panel model of hospital admission for respondents aged 50 years or more.nnnPRINCIPAL FINDINGSnFollowing 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 2.1 percent on average.nnnCONCLUSIONSnOur results support promotion of early detection of frailty in primary care, and improvement of coordination between actors within the health system, as potential strategies to reduce avoidable or unnecessary hospital use among frail elderly.

Are public subsidies effective to reduce emergency care? Evidence from the PLASA study

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 peoples 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 Alzheimers 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.

Preventing mobility disability in Europe: a health economics perspective from the SPRINTT study

In a global context of population aging, gaining better knowledge of the mechanisms leading to loss of autonomy has become a major objective, notably with the aim of implementing effective preventive health policies. The concept of frailty, originally introduced in gerontology and geriatrics as a precursor state to functional dependency, appears as a useful tool in this specific context. The “Sarcopenia and Physical fRailty IN older people: multi-componenT Treatment strategies” (SPRINTT) project will provide a unique opportunity to explore health economics issues associated with frailty. In terms of health economics, the loss of autonomy approach retained here focuses on the economic and social causes and consequences of the onset of frailty in older adults, and examines the challenges not only in terms of health system efficiency but also in terms of social protection.

The impact of economic conditions on the disablement process: A Markov transition approach using SHARE data

A growing number of studies underline the relationship between socioeconomic status and health at older ages. Following that literature, we explore the impact of economic conditions on changes in functional health overtime. Frailty, a state of physiological instability, has been identified in the public health literature as a candidate for disability prevention but received little attention from health economists. Using SHARE panel data, respondents aged 50 and over from ten European countries were categorised as robust, frail and dependent. The determinants of health states changes between two interviews were analysed using multinomial Probit models accounting for potential sample attrition. A particular focus was made on initial socioeconomic status, proxied by three alternative measures. Concentration indices were computed for key transition probabilities. Across Europe, poorer and less educated elders were substantially more likely to experience health degradations and also less likely to experience health improvements. The economic gradient for the recovery from frailty was steeper than that of frailty onset, but remained lower than that of dependency onset. The existing social programs in favour of deprived and dependent elders could be widened to those diagnosed as frail to reduce the onset of dependency and economic inequalities in health at older ages.

Social Participation and Health: A Cross-Country Investigation among Older Europeans

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.