Abstract
SummaryBackgroundReliable estimation of future trends in life expectancy and the burden of disability is crucial for ageing societies. Previous forecasts have not considered the potential impact of trends in disease incidence. The present prediction model combines population trends in cardiovascular disease, dementia, disability, and mortality to forecast trends in life expectancy and the burden of disability in England and Wales up to 2025.MethodsWe developed and validated the IMPACT-Better Ageing Model—a probabilistic model that tracks the population aged 35–100 years through ten health states characterised by the presence or absence of cardiovascular disease, dementia, disability (difficulty with one or more activities of daily living) or death up to 2025, by use of evidence-based age-specific, sex-specific, and year-specific transition probabilities. As shown in the English Longitudinal Study of Ageing, we projected continuing declines in dementia incidence (2·7% per annum), cardiovascular incidence, and mortality. The model estimates disability prevalence and disabled and disability-free life expectancy by year.FindingsBetween 2015 and 2025, the number of people aged 65 years and older will increase by 19·4% (95% uncertainty interval [UI] 17·7–20·9), from 10·4 million (10·37–10·41 million) to 12·4 million (12·23–12·57 million). The number living with disability will increase by 25·0% (95% UI 21·3–28·2), from 2·25 million (2·24–2·27 million) to 2·81 million (2·72–2·89 million). The age-standardised prevalence of disability among this population will remain constant, at 21·7% (95% UI 21·5–21·8) in 2015 and 21·6% (21·3–21·8) in 2025. Total life expectancy at age 65 years will increase by 1·7 years (95% UI 0·1–3·6), from 20·1 years (19·9–20·3) to 21·8 years (20·2–23·6). Disability-free life expectancy at age 65 years will increase by 1·0 years (95% UI 0·1–1·9), from 15·4 years (15·3–15·5) to 16·4 years (15·5–17·3). However, life expectancy with disability will increase more in relative terms, with an increase of roughly 15% from 2015 (4·7 years, 95% UI 4·6–4·8) to 2025 (5·4 years, 4·7–6·4).InterpretationThe number of older people with care needs will expand by 25% by 2025, mainly reflecting population ageing rather than an increase in prevalence of disability. Lifespans will increase further in the next decade, but a quarter of life expectancy at age 65 years will involve disability.FundingBritish Heart Foundation.
Highlights
The substantial expansion in life expectancy and population ageing during the 20th century is continuing into the 21st century
Model design We developed and validated the IMPACT-Better Ageing Model (IMPACT-BAM)—a discrete-time probabilistic Markov model that follows the progression of a healthy population of England and Wales from 2006 to 2025 into eight different states characterised by the presence or absence of cardiovascular disease, cognitive impairment, and moderate-to-severe functional impairment, and two states for death from cardiovascular disease and noncardiovascular disease causes
Our projections indicate that the number of people in England and Wales aged 65 years and older will increase by roughly 19·4% (95% uncertainty intervals (UIs) 17·7–20·9), from 10·4 million (10·37–10·41 million) in 2015, to 12·4 million (12·23–12·57 million) in 2025
Summary
The substantial expansion in life expectancy and population ageing during the 20th century is continuing into the 21st century. Life expectancy at age 65 years among the 27 countries of the European Union has increased from 17·8 years in 2002, to 20·0 years in 2014.1 Rapid ageing of populations in developed countries is set to continue; evidence about trends in morbidity and disability prevalence in the past few decades is inconsistent.[2,3]. In the UK, concerns exist regarding potential increases in agerelated disability. Between 1991 and 2011, findings from the Cognitive Function and Ageing Study (CFAS)[4] showed that total life expectancy and disabilityfree life expectancy increased, the proportion of life without disability decreased
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