Prepandemic life expectancy rises in older adults, but disability remains constant

Prior to the COVID-19 pandemic, life expectancy at age 70 years has continued to rise across the globe due to reductions in chronic diseases, according to a recent study. However, disability burden persists and indicates the need to improve public health and intervention initiatives to enhance well-being among older adults.

“Globally adults aged ≥70 were found to live substantially longer in 2019 than in 1990, particularly owing to decreases in death due to cardiovascular diseases and chronic respiratory diseases,” the researchers said. “However, disability burden rates are following a stable pattern mostly attributable to functional decline, injuries due to falls, hearing loss, and back pain.”

In this systematic analysis of older adults aged ≥70 years from 204 countries and territories, data were obtained from the Global Burden of Diseases, Injuries, and Risk Factors Study 2019 (GBD 2019) to assess mortality and disability trends in this population and to evaluate patterns in causes of death, disability, and risk factors.

The researchers estimated the following outcomes measures based on standardized GBD methods: years of life lost, years lived with disability, disability adjusted life years, life expectancy at age 70 (LE-70), healthy life expectancy at age 70 (HALE-70), proportion of years in ill health at age 70 (PYIH-70), risk factors, and data coverage index.

All-cause death rates decreased for men and women even as the population of older adults had increased since 1990 globally. However, the rates of mortality owing to falls rose between 1990 and 2019. Among people aged 70‒90 years, the probability of death also decreased due to reductions in noncommunicable diseases. [BMJ 2022;376:e068208]

Notably, worldwide disability burden was driven primarily by functional decline, vision and hearing loss, and symptoms of pain.

Globally, LE-70 and HALE-70 continued to increase since 1990, with certain disparities in some regions. Higher LE-70 led to higher HALE-70 and to a slight increase in PYIH-70. LE-70 and HALE-70 were positively associated with sociodemographic and healthcare access and quality indices.

Data coverage was moderate for high-exposure risk factors. On the other hand, available data for various dietary, environmental or occupational, and metabolic risks were limited.

“Our findings show we should develop and implement targeted strategies aimed at functional ability, sensory organ deficits, symptoms of pain, and unintentional falls,” the researchers said. “Programs need to address country-specific sociodemographic and cultural development because universal plans might be inefficient.”

Implications on policies, data collection

In addition, these findings held some implications for health policy and data collection. First, country-specific benchmarks could be applied to develop and implement health interventions to reduce the disability burden in older adults while tracking regional estimates. [www.euro.who.int/__data/assets/pdf_file/0006/161637/WHD-Policies-and-Priority-Interventions-for-Healthy-Ageing.pdf]

Second, cause- and risk-specific insights from this analysis could inform draft policies focusing on the prevention of functional loss and disability progression among older people, specifically targeting men and women, and various sociodemographic levels. Finally, data coverage assessment revealed fewer available health data on older adults.

“Because our analysis covers a period before the COVID-19 pandemic, we were unable to analyse the effect of covid-19 on mortality,” the researchers noted.

“COVID-19 will probably be one of the top ranked causes of death and disability adjusted life years in people aged ≥70 [years] for 2020, with studies from high income countries having consistently reported that older adults are disproportionately affected by the ongoing pandemic,” they added. [J Am Geriatr Soc 2020;68:926-929; BMC Public Health 2020;20:1742]