Nowadays, medico-social experts tend to favour the term “loss of autonomy” rather than “dependency” to describe the condition of elderly or frail individuals. This change in language is quite significant as it reflects a more nuanced approach to care. Here is an overview of what “loss of autonomy” means, how it is measured, and how to adapt care to support those who experience it.
A concept suited to a wide range of life circumstances
Loss of autonomy is commonly defined as the condition of a person who, regardless of the medical care he or she may receive, requires assistance to perform essential activities of daily living or requires regular supervision. Its causes can be physical (e.g. falls, fatigue), cognitive (e.g. impaired memory or attention) or even social (e.g. isolation).
Rather than a binary distinction between "dependency" and "independence", this definition thus reflects a holistic assessment of life situations. A fall while cycling, for example, may cause a small and temporary loss of autonomy if it results in a sprain and the use of crutches for three weeks. In contrast, a number of cognitive impairments cause a significant and irreversible loss of autonomy.
Ageing isn’t synonymous with losing one's autonomy
It’s worth emphasising that age does not feature in our definition of loss of autonomy above. Indeed, age does not exactly cause loss of autonomy so much as it increases the probability of its occurrence, for two reasons: the natural accumulation of muscular weaknesses and/or sensory deficits on the one hand, and, much more crucially, increased vulnerability to chronic diseases. The latter are a major cause of loss of autonomy at any age, but they are particularly dangerous and prevalent among the elderly: in 2021, approximately 80% of the over-65s in Europe suffered from chronic diseases, which cause 75% of deaths in this age group. Preventing and treating these illnesses, therefore, constitutes a major public health challenge.
Measuring loss of autonomy in everyday life
Health professionals generally measure autonomy by assessing a person's physical, motor and cognitive abilities to carry out the Activities of Daily Living (ADLs) essential for survival and well-being. The tools used to carry out these assessments vary from country to country and based on patient profile, such as stroke victims and elderly or frail individuals. For the latter group, many countries including the US and Belgium use the Index of Independence of Activities for Daily Living, or Katz Scale; other tools include the Gait Speed Test and PRISMA-7 tests in England, and the AGGIR scale (Autonomy Gerontology Group Iso-Resources) in France.
A holistic approach to loss of autonomy
Beyond the medical issue of assessing loss of autonomy, there must also be a social and personal approach to care. That is Korian’s outlook and expertise, with medical and care teams offering local, tailored and flexible solutions to each individual situation. For example, people who are relatively autonomous can access personal services at home, such as those offered by the Petit-Fils network. Community-based solutions are also available in the form of shared housing, living communities and residential services. Medical and rehabilitation care, including at home, can also be provided on an ad hoc or ongoing basis. Finally, long-term care nursing homes are suitable for individuals who are most isolated and/or experiencing significant loss of autonomy. Autonomy is at the heart of the Positive Care approach developed by Korian, with a strong emphasis on non-drug therapies, which aim to preserve and stimulate physical, motor and cognitive abilities.
A future-ready approach to care underpinned by scientific research Preventing and treating loss of autonomy and chronic diseases are two key priorities of Korian’s group scientific research, which is integral to its “Positive Care” approach. The Korian foundations in France and Germany, as well as the countries' Medical Strategy and Health Innovation Departments, are actively involved in clinical research projects and social studies, in collaboration with university and scientific partners.
References and further reading:
Alzheimer’s Association Documents:
World Health Organization:
L’Appui carers organisation: