Focus on disability-free life expectancy: implications for health-related quality of life

Abstract

Background Since the end of the industrial revolution, advances in public health and clinical medicine have contributed to dramatic decreases in infant and childhood mortality, improvements in health-related quality of life (HRQoL), increases in overall life expectancy (LE), and rectangularization of survival curves. Objectives In this article, we focus on disability that has occurred with the overall lengthening of LE in many populations and the implications this has for decreased HRQoL. Methods We utilize the concept of rectangularization of population survival to depict the rising prevalence of disability associated with increased LE, especially among racial and ethnic minorities and people of low socioeconomic status (SES) and relate this to HRQoL. Results Disability-free life expectancy (DFLE) and healthy life expectancy (HLE) are defined in terms of HRQoL. Specific attention is focused on disability experienced by disparate populations around the globe. By focusing on disparities in DFLE, and the need to expand LE to include HLE as a central component of HRQoL, this work provides an important counterpoint to the attention that has been paid to LE disparities according to race, gender, ethnicity, education, and SES. Discussion By calling attention to those factors that appear to be the most important drivers of the differences in quality and length of DFLE between different groups (i.e., the components of the social gradient, exposure to chronic stress, systemic inflammation, and the psychological and biological mechanisms associated with the gut–brain axis) and, by logical extension, HRQoL, we hope to promote research in this arena with the ultimate goal of improving DFLE, HLE, and overall HRQoL, especially in disparate populations around the globe.

Reconceptualizing Geriatric Care in a Sub-Saharan African Context

“…Across the globe, various initiatives have been put in place to improve the health outcomes of the elderly, to lengthen their life span and decrease the rate of morbidity and mortality of the older adult which in turn increases their numbers among the population [2][3][4]. The use of comprehensive geriatric assessment (CGA) for assessment, goal setting and care delivery has been adopted in the United Kingdom to improve relational working [5][6].…”

Multimorbidity and long-term disability and physical functioning decline in middle-aged and older Americans: an observational study

“…Similarly, decreased upper body strength assessed through grip strength was associated with functional limitations and disability in older adults, poor health-related quality of life, and increased mortality risk [6][7][8]. Avoiding disability is universally valued, and recent analyses have highlighted disability-free survival as an important health outcome over mere overall survival [9,10].…”

How aging of the global population is changing oncology

“…As population aging proceeds, lifestyle-related cancers may diverge into two strata: a younger group which more often has cardiovascular disease or diabetes, and an older group whose main risk factor is age alone [ 75 ]. The functional extremes, or stereotypes, of older adults with cancer – i.e., physiologically older or physiologically younger – illustrate the breadth of the wellness-illness spectrum in older individuals [ 76 ], highlighting the notion of health-related quality of life [ 77 ]. Physiologically older patients with cancer are by definition less fit than average for their age, based on non-cancer comorbidity [ 78 , 79 ].…”