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Making the extra years count: Inequalities in disability and dependency with increasing longevity

ILC virtual policy event on disability-free and dependency-free life expectancy.

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Making the extra years count: Inequalities in disability and dependency with increasing longevity

  1. 1. Join the conversation: @ilcuk #HealthyYears Making the extra years count: Inequalities in disability and dependency with increasing longevity
  2. 2. Join the conversation: @ilcuk #HealthyYears Welcome from chair Dr Brian Beach, Senior Research Fellow, ILC
  3. 3. What is ILC? ILC is the UK’s specialist think tank on the impact of longevity on society and what happens next. We: • Are independent and politically neutral • Use evidence-based research for policy • Work collaboratively to pioneer solutions for the future Our work focuses on three strategic priorities: • Maximising the benefits of longevity • Ensuring longer lives are good for everyone • Future-proofing policy and practice Join the conversation: @ilcuk #InternalisedAgeism
  4. 4. Partners Programme Be part of what happens next Join the conversation: @ilcuk # InternalisedAgeism
  5. 5. Join the conversation: @ilcuk #HealthyYears Presentation of findings Prof Carol Jagger, Newcastle University
  6. 6. From Newcastle. For the world. Making the extra years count - Inequalities in disability and dependency with increasing longevity
  7. 7. From Newcastle. For the world. Project team • Professor Carol Jagger • Dr Andrew Kingston • Dr Holly Q Bennett • Professor Fiona Matthews • Professor Lynne Corner • Dame Louise Robinson • Dr Ilianna Lourida • Older People and Frailty Policy Research Unit • Dr Gemma Spiers 7 Making the extra years count • Professor Tom Scharf (Chair) –Newcastle University • Professor Clare Bambra –Newcastle University • Professor Julia Newton –Academic Health Sciences Network, NE and N Cumbria • Professor Les Mayhew –CASS Business School and ILC-UK Advisory Group
  8. 8. From Newcastle. For the world. Project aims Are changes in years with disability and dependency at age 65 over the last 20 years • Due to (a) increased incidence of disability/dependency, (b) reduced ability to return to independence, or (c) longer survival with disability/dependency? • Due to individual long-term conditions becoming more prevalent, or more disabling, or because multiple conditions (multi-morbidity) have increased? • Being experienced similarly by all social groups? 8 Making the extra years count – aims Definitions • Disability –Difficulties or help required with basic or instrumental activities of daily living (ADL and IADL) • Dependency –Help required with ADL or IADL or severe cognitive impairment –Reflects lapsed time requiring help
  9. 9. From Newcastle. For the world. • Life expectancy increases have slowed and have reversed since Covid (Aburto et al., JECH 2021) • National trends usually based on X-sectional data - limited ability to understand drivers • Unique longitudinal data for 2 generations of people aged 65+ in 1991 and 2011 from the Cognitive Function and Ageing Studies 9 Background No disability Disability Disability No disability Dead Baseline 2-yr follow-up Longitudinal data
  10. 10. From Newcastle. For the world. Four key messages from the project Between 1991 and 2011 • Inequalities increased substantially because the “richest” experienced delayed disability – the “poorest” longer life with disability • Women with some health conditions experienced a reduction in disability • The “poorest” saw a much greater increase in the prevalence of multiple long-term conditions (MLTCs) - but this didn’t explain the inequalities • It IS possible to delay disability even in the presence of MLTCs 10 Making the extra years count – key messages
  11. 11. From Newcastle. For the world. DFLE gap 1.0 year 2.7 years 0.7 years 3.1 years Disability gap 0.1 year 0.8 years 0.8 years 0.7 years Making the extra years count – DFLE at age 65 by deprivation
  12. 12. From Newcastle. For the world. 12 Making the extra years count – new statistic DFLE50% • DFLE (along with LE and DLE) usually reported at a single age – i.e. age 65 • If these quantities are illustrated across the age range there is a point where the DFLE line crosses the DLE line – a turning point • This turning point (DFLE50%) is the age at which 50% of remaining life is spent free of disability and 50% with disability • From this age the majority of remaining life will be spent with disability 0 5 10 15 20 25 65 70 75 80 85 90 95 Years Age 1991 Most advantaged men 1991 Life expectancy 1991 Disability-free life expectancy 1991 Life expectancy with disability 1991 DFLE50%: 79
  13. 13. From Newcastle. For the world. DFLE50% by deprivation – change from 1991 to 2011 - MEN Most advantaged Least advantaged 0 5 10 15 20 25 65 70 75 80 85 90 95 Years Age 2011 DFLE50%: 85 1991 DFLE50%: 79 0 5 10 15 20 25 65 70 75 80 85 90 95 Years Age 2011 DFLE50%: 79 1991 DFLE50%: 77 1991 Life expectancy 1991 Disability-free life expectancy 1991 Life expectancy with disability 2011 Life expectancy 2011 Disability-free life expectancy 2011 Life expectancy with disability
  14. 14. From Newcastle. For the world. Most advantaged Least advantaged DFLE50% by deprivation – change from 1991 to 2011 - WOMEN 0 5 10 15 20 25 65 70 75 80 85 90 95 Years Age 2011 DFLE50%: 73 1991 DFLE50%: 68 0 5 10 15 20 25 65 70 75 80 85 90 95 Years Age 2011 DFLE50%: 67 1991 DFLE50%: 68 1991 Life expectancy 1991 Disability-free life expectancy 1991 Life expectancy with disability 2011 Life expectancy 2011 Disability-free life expectancy 2011 Life expectancy with disability Source: Bennett, Kingston, Spiers et al. IJE (2021)
  15. 15. From Newcastle. For the world. What is driving the widening inequalities? Men • Most advantaged − 30% reduction in incident disability − 80% increase in recovery − 60% reduction in death from a disability-free state • Least advantaged − 30% reduction in death from disability state – therefore longer life with disability Women • Most advantaged − 30% reduction in incident disability • Least advantaged − No change in any transitions 15 Making the extra years count – why are inequalities widening? No disability Disability Disability No disability Dead Baseline 2-yr follow-up
  16. 16. From Newcastle. For the world. Change in long-term conditions between 1991 and 2011? • Prevalence (odds) − Diabetes and peripheral vascular disease (PVD) more than doubled − Coronary Heart Disease (CHD) and hearing difficulties increased by 20% − Cognitive impairment reduced by 40% • Disabling effect − In men all conditions resulted in an increase in years with disability between 1991 and 2011 with smallest increase for PVD (0.7 years) − In women there was a reduction in years with disability with arthritis (0.2 yrs), CHD (1.1 yrs), diabetes (0.2 yrs), hearing difficulties (0.5 yrs), respiratory disease (0.6 yrs) − Largest increase for cognitive impairment for men (1.8 yrs) and women (1.3 yrs) 16 Making the extra years count – the role of single long-term conditions Less in CFAS II More in CFAS II
  17. 17. From Newcastle. For the world. What is the role of multiple long-term conditions (MLTCs)? Between 1991 and 2011 • Prevalence of MLTCs − The overall prevalence of MLTCs increased but only in 65-74 years age group − Prevalence of MLTCs changed little for most advantaged but increased by 10 percentage points in least advantaged • For men and women with MLTCs there was hardly any DFLE inequality by deprivation in 1991 – by 2011 DFLE inequality had tripled to around 2.5 years • Increase in DFLE inequality similar in men and women without MLTCs - so MLTCs not all the reason for DFLE inequality • Most advantaged men and women with MLTCs had a reduction in disability incidence 17 Making the extra years count – the role of multiple long-term conditions
  18. 18. From Newcastle. For the world. Four key messages from the project Between 1991 and 2011 • Inequalities increased substantially because the “richest” experienced delayed disability – the “poorest” longer life with disability • Women with some health conditions experienced a reduction in disability • The “poorest” saw a much greater increase in the prevalence of multiple long-term conditions (MLTCs) - but this didn’t explain the inequalities • It IS possible to delay disability even in the presence of MLTCs 18 Making the extra years count – key messages
  19. 19. From Newcastle. For the world. 19 Making the extra years count - acknowledgements CFAS studies collaboration
  20. 20. ncl.ac.uk Making the extra years count – Inequalities in disability and dependency with increasing longevity Thank you
  21. 21. Join the conversation: @ilcuk #HealthyYears Response Prof Les Mayhew, ILC & Cass Business School
  22. 22. Counting the cost of inequalities Les Mayhew Professor of statistics, the Business School, City University, London Head of Global Research ILC
  23. 23. Research issues arising • What is the significance of an increasing gap between health and life expectancy i.e. more years spent with disability or poor health? • Are these avoidable years i.e. can something be done earlier in life to address problems later on or do we put our faith in medical research? • Can we put a value on an increasing gap in terms of pensions, health and welfare costs and if so how to do that? • What does it tell us about policies to improve health versus life extensions i.e. the prevention versus treatment argument?
  24. 24. An illustrative chart combining life, health and work spans 20 30 40 50 60 70 80 90 LLL HHH HHM LLL LLL MMM Hartlepool Windsor and Maidenhead Richmond upon Thames Birmingham Liverpool Leeds Age Unhealthy years Inactive healthy years Working lives State Pension Age
  25. 25. Where to next? Ideally….. •A life course approach based on adults of working age focusing on health and work and the economics of ageing •An accounting framework combining demographic, health, economic variables with fiscal effects •A ‘what-if’ capability e.g. what is the impact on economic growth and the fiscal implications of a one-year improvement in health •Creation of a single overarching measure of inequality combining these concepts
  26. 26. Join the conversation: @ilcuk #HealthyYears Response Prof Sir Michael Marmot, UCL Institute of Health Equity
  27. 27. Join the conversation: @ilcuk #HealthyYears Response Baroness Young of Old Scone
  28. 28. Join the conversation: @ilcuk #HealthyYears Response Prof Sir Muir Gray, Optimal Ageing Programme
  29. 29. Join the conversation: @ilcuk #HealthyYears Response Dr Alison Giles, Public Health England
  30. 30. Join the conversation: @ilcuk #HealthyYears Q&A discussion
  31. 31. Join the conversation: @ilcuk #HealthyYears Closing remarks Dr Brian Beach, ILC
  32. 32. Work with us Business intelligence: we’ll give you advance notice of our latest research, ad hoc briefings on areas of specific interest to your organisation, as well as a discount on any research you commission from us. Networks and connections: our Partners events have included visits to Number 10, briefings with prominent influencers, as well as the opportunity to meet ministers, policy experts and fellow Partners. Brand benefits: as a Partner your brand will be visible through our numerous events, press releases and presentations, and give you the opportunity to be positioned at the heart of the debate on longevity. For more information contact Redvers Lee: redverslee@ilcuk.org.uk
  33. 33. Delivering prevention in an ageing world Find out more: https://ilcuk.org.uk/delivering- prevention-in-an-ageing-world/ @ilcuk #DeliveringPrevention
  34. 34. Join the conversation: @ilcuk #HealthyYears Thank you

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