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Trends in disability-free life expectancy at age 65 in France: consistent and diverging patterns according to the underlying disability measure.

ABSTRACT: Disability-free life expectancy estimates (DFLE) are summary measures to monitor whether a longer life expectancy (LE) is associated with better health or whether additional years of life are years of poor health or disability. Disability is a generic term defined as the impact of disease or injury on the functioning of individuals. It covers various situations from the rather common functional limitations to restrictions in daily activities and finally dependency. Disentangling these dimensions is essential to monitor future needs of care and assistance; but this is not always feasible since surveys do not systematically cover a large range of disability dimensions in their questionnaires. This study aims to cover different disability dimensions by using data from different French population surveys. We computed ten disability-free life expectancies, based on both specific and generic disability indicators from four population health surveys, in order to describe and compare trends and patterns for France over the 1980s and the 1990s. We used the Sullivan method to combine prevalence of disability and life tables. In 2000, two thirds of total LE at age 65 are years with physical or sensory functional limitations and 10% are years with restrictions in personal care activities. Trends in DFLE over the two last decades seem to have remained stable for moderate levels of disability and to have increased for more severe levels of disability or activity restrictions. We found that patterns are consistent from one survey to the other when comparing indicators reflecting similar disability situations.

SUBMITTER: Cambois E

PROVIDER: S-EPMC5546295 | biostudies-other | 2008 Dec

REPOSITORIES: biostudies-other

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Project description:BackgroundReliable estimation of future trends in life expectancy and the burden of disability is crucial for ageing societies. Previous forecasts have not considered the potential impact of trends in disease incidence. The present prediction model combines population trends in cardiovascular disease, dementia, disability, and mortality to forecast trends in life expectancy and the burden of disability in England and Wales up to 2025.MethodsWe developed and validated the IMPACT-Better Ageing Model-a probabilistic model that tracks the population aged 35-100 years through ten health states characterised by the presence or absence of cardiovascular disease, dementia, disability (difficulty with one or more activities of daily living) or death up to 2025, by use of evidence-based age-specific, sex-specific, and year-specific transition probabilities. As shown in the English Longitudinal Study of Ageing, we projected continuing declines in dementia incidence (2·7% per annum), cardiovascular incidence, and mortality. The model estimates disability prevalence and disabled and disability-free life expectancy by year.FindingsBetween 2015 and 2025, the number of people aged 65 years and older will increase by 19·4% (95% uncertainty interval [UI] 17·7-20·9), from 10·4 million (10·37-10·41 million) to 12·4 million (12·23-12·57 million). The number living with disability will increase by 25·0% (95% UI 21·3-28·2), from 2·25 million (2·24-2·27 million) to 2·81 million (2·72-2·89 million). The age-standardised prevalence of disability among this population will remain constant, at 21·7% (95% UI 21·5-21·8) in 2015 and 21·6% (21·3-21·8) in 2025. Total life expectancy at age 65 years will increase by 1·7 years (95% UI 0·1-3·6), from 20·1 years (19·9-20·3) to 21·8 years (20·2-23·6). Disability-free life expectancy at age 65 years will increase by 1·0 years (95% UI 0·1-1·9), from 15·4 years (15·3-15·5) to 16·4 years (15·5-17·3). However, life expectancy with disability will increase more in relative terms, with an increase of roughly 15% from 2015 (4·7 years, 95% UI 4·6-4·8) to 2025 (5·4 years, 4·7-6·4).InterpretationThe number of older people with care needs will expand by 25% by 2025, mainly reflecting population ageing rather than an increase in prevalence of disability. Lifespans will increase further in the next decade, but a quarter of life expectancy at age 65 years will involve disability.FundingBritish Heart Foundation.

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Trends in disability-free life expectancy at age 65 in France: consistent and diverging patterns according to the underlying disability measure.

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