There have been advances in healthcare over recent decades that mean many people with chronic health conditions are living longer. In the new study, researchers wanted to determine whether this extension to life involves an increase in years with or without disability. The team analyzed data from two large population-based studies of people aged 65 or over in England. The studies, the Cognitive Function and Aging Studies (CFAS I and II) involved baseline interviews with 7,635 people in 1991-1993 and with 7,762 people in 2008-2011, with two years of follow-up in each case.
For both healthy people and those with health conditions, the average years of disability-free life expectancy (DFLE) increased from 1991 to 2011. Overall, men gained 4.6 years in life expectancy (95% CI: 3.7 — 5.5 years, p<0.001)) and 3.7 years in DFLE (95% CI: 2.7 — 4.8, p<0.001)). Men with conditions including arthritis, coronary heart disease, stroke and diabetes gained more years in DFLE than years with disability. The greatest improvements in DFLE in men were seen for those with respiratory difficulties and those living post-stroke.
Between 1991 and 2011, women experienced an increase in life expectancy at age 65 years of 2.1 years (95% CI: 1.1- 3.0 years, p<0.001), and an increase in DFLE of 2.0 years (95% CI: 1.0 — 2.9 years, p<0.001). Similar to men, most improvement in life expectancy for women with long-term conditions was in disability-free years. However, women with cognitive impairment experienced an increase in life expectancy with disability (1.6 years, 95% CI: 0.1 — 3.1, p=0.04) without any improvement in DFLE. Men with cognitive impairment experienced only a small increase in DFLE (1.4 years, 95% CI: -0.7 — 3.4, p=0.18) with an increase in life expectancy with disability that was comparable in magnitude (1.4 years, 95%CI: 0.2-2.5, p=0.02). Therefore, at age 65, the percentage of remaining years of life which were spent disability-free decreased for men with cognitive impairment (difference CFAS II — CFAS I: -3.6%, 95% confidence interval (CI): -8.2 — 1.0, p=0.12) and women with cognitive impairment (difference CFAS II — CFAS I: -3.9%, 95% CI: -7.6 — 0.0, p=0.04).
“While these findings are mostly positive, we found an increase in the percentage of remaining years spent with disability for men and women with cognitive impairment. Given cognitive impairment was also the only long-term condition where prevalence decreased this is a cause for concern and requires further investigation,” the authors say.
The authors concluded, “Our study is the first, to our knowledge, to estimate temporal trends in LE and DFLE with health conditions from longitudinal data and separately for men and women. We found that the underlying transitions influencing trends in DFLE for those with health conditions differed between men and women. Improvements for women with health conditions may be related to reduced disability incidence and improvements for men from reductions in the probability of death. For women, reductions in incident disability were great enough that DFLE increased and DLE decreased in the presence of CHD. While these findings are positive, we also found a decline in the percentage of remaining years spent disability-free for men and women with cognitive impairment. Given that cognitive impairment was also the only LTC where prevalence decreased, this is a cause for concern and requires further investigation.”
