Trend in Disability-Free Life Expectancies in France: Younger, Older, Men or Women, Who Benefitted Most?

Emmanuelle Cambois, INED
Amélie Carrère, Université Paris Dauphine
Jean-Marie Robine, EPHE

Although disability-free life expectancies (DFLE) in France have followed a rather favourable trend over 1990’s, the early 2000’s were characterized by an unexpected expansion of the years lived with activity restrictions; this expansion was concentrated at the end of the working ages. This pattern was more pronounced for women than for men. It was also found that a number of baby-boomer generations in France did not benefit as much as the previous and next generations from the mortality decline. In this paper, we present the 25 year trend in DFLE for France, exploring the trends and patterns across age groups and genders.

Trends in DFLE were assessed using six population surveys. Several dimensions of disability are measured based on the framework of the disablement process: (1) sensory (FL_S); physical (FL_P); and cognitive (FL_C) functional limitations, and (2) long-term global activity limitations (RA_GAL); restriction in elementary activities of daily living (RA_ADL); restriction in instrumental activities of daily living (RA_IADL). Disability-free life expectancies (DFLE) were computed for each category and each available years using Sullivan method. We presented the estimates at age 50 and 65 and partial DFLE in the 50-64 age range.

Trends in various DFLEs in France indicated less favourable trends in the first decade of 2000 than in the 1990’s regarding activity restrictions. After an unexpected expansion of the disability years in the early 2000’s, we observed a new increase in some DFLE in the most recent years, however not as important as the increase in LE. The expansion of disability was therefore prolonged in the early 2010’s, with the exception of cognitive limitations. The gender gap was still large for all disability dimensions especially physical functional limitations and IADL restrictions. We discuss these trends and patterns in the light of possible effect of generations.


INTRODUCTION

Increasing life expectancy (LE) raises the question at the policy level of the healthy aging and care needs and also of actions for extending participation at older ages; however, social participation requires these extra years to be healthy years. The health gains or loss accompanying the increasing LE determine the quality of life of an increasing part of the population and the future needs for long-term care systems. Three scenarios for future trends in population health and adult life expectancy have dominated the question since the 1980s: expansion of disability, compression of morbidity, and a dynamic equilibrium in trends in frequency and in severity of disability. In this context, disability-free life expectancies (DFLE) have become key indicators for monitoring population health developments alongside with the increasing LE. Since the eighties, population surveys worldwide have provided large scale data to monitor trends in DFLE and researchers have accumulated a great knowledge. However, these researches have demonstrated especially in recent years that there was not a single answer to the question “are we living longer and healthier”? Three concerns emerged: (1) the changing trends in the healthy years according to the disability dimensions and periods of time; (2) the unexpected variation in these trends across age-groups and generations; (3) the puzzling gender differences, with a female advantage in terms of LE but disadvantage in terms of time spent unhealthy and with disability. Based on previous findings for France and new datasets, this paper presents 25-year trends and patterns in French disability-free life expectancies and discusses these three concerns: trends in DFLE according to the disability dimensions, the variations observed across age-groups and gender differences.

DATA AND METHODS

We used 6 population surveys. DFLE were computed based on 6 different disability dimensions of the disablement process: sensory (FL_S); physical (FL_P); and cognitive (FL_C) functional limitations; long-term global activity limitations (RA_GAL); restriction in basic activities of daily living (RA_ADL); restriction in instrumental activities of daily living (RA_IADL). DFLE were computed at age 50 and 65. We also considered the 50-65 age-group, to highlight specific trends and patterns in mid-adulthood. We used the Sullivan method. Confidence intervals were estimated taking into account the sample sizes of the health survey.

RESULTS

DFLE patterns according to age group and sex

Table 1 summarizes the estimations of DFLE based on the surveys conducted in in France. At age 50, women can expect to live 5 more years than men; however they spent much more years with physical functional limitations (11 to 13 years for men vs 19 to 22 years for women); the part of LE to be lived free of functional limitations was around 60% for men and 40% for women. The gender difference was also found after age 65 at which men can expect to live 9-11 years with physical functional limitations out of their 19 years of LE and women 15 to 17 years out of their 23 years of LE. Mental/cognitive limitations are the least frequent functional limitations; 86-94% of LE50 was free of such limitations. Sensory limitations were the unique limitations for which men are disadvantaged in terms of percentage of the LE free of functional limitations. Regarding activity restriction, men at age 50 can expect to live 55-58% of their LE without GAL restriction, women a little less (50-54%). Men can expect to live 85% of their LE at age 50 without ADL restriction and women and 82%. Women’s longer LE induces more years with disability than men’s LE; women also spent fewer years without physical limitations, general activity limitations and IADL restrictions.

Trends in DFLE

Since the 1990''s, LE without RA_ADL followed positive trends for both sexes, generally close to the trends in LE, except in more recent years for women; the DFLE increased but less than LE, suggesting for them more years lived with ADL restrictions. The SHARE survey indicated a similar pattern for the IADL restrictions. Regarding the general activity limitations (GAL), SHARE, EU-SILC and ESPS estimates indicated a decrease in DFLE around 2010, and an increase in the most recent years. These trends were observed at age 50 and at age 65 and for both genders.

The LEs without physical limitations decreased after 2005 and were stable in the recent years, meaning an increase in LEs with such limitations, although less pronounced in recent years. LEs without sensory limitations have followed the same trends at age 50, but have more regularly increased at age 65.

Although we found a favourable pattern regarding cognitive functioning, the other indicators indicate that the expansion of disability observed in the early 2000’s was prolonged in recent years, however to different extent according to the disability dimension, the age-group and gender. We discuss whether these new findings could be attributed to some generations of baby-boomers that showed a specific aging context in France and elsewhere.

Presented in Session 1200: Mortality and Longevity