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Making the extra years count: Inequalities in disability and dependency with increasing longevity
1. Join the conversation: @ilcuk
#HealthyYears
Making the extra years count:
Inequalities in disability and dependency with
increasing longevity
2. Join the conversation: @ilcuk
#HealthyYears
Welcome from chair
Dr Brian Beach, Senior Research Fellow, ILC
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
5. Join the conversation: @ilcuk
#HealthyYears
Presentation of findings
Prof Carol Jagger, Newcastle University
6. From Newcastle. For the world.
Making the extra years count - Inequalities
in disability and dependency with
increasing longevity
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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. From Newcastle. For the world. 19
Making the extra years count - acknowledgements
CFAS studies collaboration
20. ncl.ac.uk
Making the extra years count – Inequalities
in disability and dependency with increasing
longevity
Thank you
21. Join the conversation: @ilcuk
#HealthyYears
Response
Prof Les Mayhew, ILC & Cass Business School
22. Counting the cost of inequalities
Les Mayhew
Professor of statistics, the Business School, City
University, London
Head of Global Research
ILC
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. 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. 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. Join the conversation: @ilcuk
#HealthyYears
Response
Prof Sir Michael Marmot, UCL Institute of Health
Equity
33. 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
34. Delivering prevention in an ageing
world
Find out more:
https://ilcuk.org.uk/delivering-
prevention-in-an-ageing-world/
@ilcuk
#DeliveringPrevention
We have an actively engaged network of experts, policy makers and practitioners, including long standing relations with UCL; our first partner
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These are results for disability.
The graphs show disability-free life expectancy, life expectancy with disability and total life expectancy at age 65.
There are a few things to point out on these graphs
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The DFLE50% is where the disability-free life expectancy dashed line and life expectancy with disability dotted line cross
It is the age at which disability-free years and years with disability are equal so where 50% of remaining life expectancy is spent disability-free or with disability.
For men this age is relatively equal in CFAS I across SES groups with only a two year difference between the most advantaged and least advantaged.
However improvements between CFAS I and CFAS II were far greater for the most advantaged men compared to least advantaged men resulting in an increase in DFLE50% from age 79 to age 85 for the most advantaged men and only an increase from age 77 to 79 for the least advantaged men.
In CFAS II the difference in DFLE50% between most and least advantaged men is 6 years, wider than the difference in CFAS I of 2 years.
If we look at the same for women, in CFAS I the age where life expectancy with and without disability is equal is same for the most and least advantaged.
While the most advantaged women see improvements between CFAS I and II with an increase from age 68 to 73 in DFLE50%, there was potentially a decrease in DFLE50% of a year from age 68 to 67 for the least advantaged
So even though there is no difference in DFLE50% between the most and least advantaged women in CFAS I, by CFAS II there is a difference of 6 years.
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We have an actively engaged network of experts, policy makers and practitioners, including long standing relations with UCL; our first partner
