DEPENDENCY - HAZARD OR INEVITABILITY

This is the burning issue of the hour. In attempting to resolve it wit hin the context of advanced age, it is important to clarify the meanin g of the words involved: - Independence and autonomy are far from bein g synonyms. Independence refers to the ability to perform physical act ivities of daily living (bathing, eating, preparing meals, shopping, m oney management), whereas the second word, autonomy refers more to the ability to make decisions, to reason, to express an appropriate opini on in a given situation. - Hazard and inevitability are totally at var iance. Hazard implies the likelihood of occurrence of an event harmful to health, or to the length or quality of life. Hazard is more or les s predictable, whereas inevitability is the expression of a supernatur al power controlling all events. To find our whether ''dependency is a hazard or an inevitability'', it is necessary to conduct a historical review of the extension in human longevity and in particular of the c urrent ''weight'' of aging both on individuals and on society at large . In Geneva, the proportion of the over 65-year-olds grew from 5.1 per cent in 1880 to 13.4 percent in 1990. During that time, the gain in li fe expectancy was 52.4 percent for Geneva males of 80 years of age and 93 percent for Geneva females of the same age. This drastic change in age groups was coupled with a noteworthy change in household sizes. I n 1860, the number of persons per household was 4.5. In 1990, it was d own to 2.2. Conversely, the number of inmates in Geneva's medico-socia l institutions went up from 649 to 1168 between 1982 and 1992. In this socio-economic and cultural perspective, the concept of ''globality o f the individual'' throughout his lifetime explains: - age-related phy siological changes; - the long-term repercussion of physical, professi onal or leisure activities; - the consequences of the accumulation of such varied risk factors as overweight or its opposite, malnutrition, tobacco or stress. - Such frailty caused by aging is an ideal breeding ground for disease. - For now, what matters most is the functional co nsequence of disease. Is the disease acute or chronic? Two out of thre e deaths result from a chronic disease, which caused loss of function by organs (impairment), loss of function by the subject himself (disab ility) or loss of function by the individual in society (social handic ap or disadvantage). Raising the question ''Dependency : a hazard or a n inevitability?'' boils down to asking oneself about the place of dis ease in our society and its determinants, and about all aspects of med icine and especially of prevention. When detected, a susceptibility br ings into play primary prevention, aimed at averting the onset of tile disease. After a disease has set in, measures to prevent recurrence, or secondary prevention, are required. Lastly, prevention of dependenc y and of loss of autonomy is part of tertiary prevention. Except for v iolent traumatic accidents, the formulation of the above concepts prov es that dependency is essentially ''a hazard''. Therefore, let us anti cipate.