Abstract
The Medicare Health Outcome Survey (HOS) is the largest longitudinal survey of the U.S. community-dwelling elderly population. This study estimated total life expectancy, active life expectancy (ALE), and disability-free life expectancy (DFLE) by disability status among HOS participants. Data were from the Medicare HOS Cohort 15 (baseline 2012, follow-up 2014). We included respondents aged ≥ 65 years (n = 164,597). Participants' disability status was assessed based on the following six activities of daily living (ADL): bathing, dressing, eating, getting in or out of chairs, walking, and using the toilet. The multi-state models were used to estimate life expectancy, ALE, and DFLE by participants' baseline disability status and age. Persons who had higher-level ADL limitations had a shorter life expectancy, ALE, and DFLE. Also persons with disability had greater expected life years with disability than those with no limitations and those with mild limitations. For example, among 65-year old respondents with no limitations, mild limitations, and disability, life expectancy was 19.9, 18.6, and 17.1 years, respectively; ALE was 14.0, 9.5, and 7.2 years, respectively; DFLE was 17.3, 15.2, and 11.4 years, respectively; and expected years with disability was 2.6, 3.4, and 5.7 years, respectively. This study demonstrated that greater levels of disability adversely impact life expectancy, ALE, DFLE, and expected number of years with a disability among U.S. older adults. Understanding levels of disability, and how these may change over time, would enhance health care quality and planning services related to home care and housing in this community-dwelling population.
Highlights
The United States population has experienced a shift in its age structure, with the number of persons aged 65 and older projected to nearly double between 2012 and 2050 [1]
This study demonstrated that greater levels of disability adversely impact life expectancy, active life expectancy (ALE), disability-free life expectancy (DFLE), and expected number of years with a disability among U.S older adults
Understanding levels of disability, and how these may change over time, would enhance health care quality and planning services related to home care and housing in this communitydwelling population
Summary
The United States population has experienced a shift in its age structure, with the number of persons aged 65 and older projected to nearly double between 2012 and 2050 [1]. What remains unclear is whether longer life expectancy is associated with the delayed onset of morbidity/disability and increases in recovery, or more years living with morbidity/disability through keeping individuals with chronic comorbid conditions alive [5, 6]. Disability-adjusted life expectancy (DFLE) or active life expectancy (ALE), defined as expected remaining life years spent in a non-disabled or “active” state, have commonly been calculated [10, 11]. These two terms (DFLE and ALE) are used interchangeably in the literature and provide a way to assess the disability-associated burden of disease [12,13,14,15]
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