Forecasted trends in disability and life expectancy in England and Wales up to 2025: a modelling study

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.

Does older adults’ use of social care influence their healthcare utilisation? A systematic review of international evidence

“…A greater volume of higher quality evidence would add weight to this conclusion. Even so, in light of the economic consequences of a projected rise in the number of older people with health and social care needs (Guzman‐Castillo et al, ), the potential for care homes to moderate costly inpatient admissions is an important finding.…”

Resurrecting the interval of need concept to improve dialogue between researchers, policymakers, and social care practitioners

“…Future analysis could explore the relationship between interval of need, support, and wealth, which would help to predict the likely sources of help (informal, Local Authority, privately paid). Another study using ELSA to simulate future projections of disability estimated that years spent in disability will increase over time, indicating expansion of morbidity, and this will be greater for women than for men (Guzman‐Castillo et al, ). What remained unanswered was the frequency with which these people will require support for those disabilities, and the present study offers an opportunity to use survey data to predict that into the future.…”

Why junior doctors need more autonomy

“…By 2025 the over 65 population is predicted to increase by nearly a fifth, and the proportion with physical and mental healthcare needs is set to rise by 25% 7. The UK is soon due to leave the European Union, with an unpredictable but inevitable impact on the current workforce.…”