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.

Keywords: Disability concepts; Disability-free life expectancy; France; Trends.

Fig. 1

Disability-free life expectancy estimates at age 65 for France between 1980 and 2003 based on ten disability indicators and four surveys (see detailed figures in Tables 1, 2, 3, 4); men and women [Changes in the survey design of the EESM 2002-2003 caused a break in the series for these estimates (Cambois et al. 2007); change in the response rate in the ESPS surveys in 2002 leads to caution in interpretation of trends over time (Auvray et al. 2003)]