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The F rench experience with G eneral a ctivity L imitation i ndicator

6 th Tasf Force on health expectancies. June 2 d 2OO8. The F rench experience with G eneral a ctivity L imitation i ndicator. Context of the GALI question. An increasing need for comparable information on disability in Europe.

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The F rench experience with G eneral a ctivity L imitation i ndicator

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  1. 6th Tasf Force on health expectancies. June 2d 2OO8 The French experience with Generalactivity Limitation indicator

  2. Context of the GALI question An increasing need for comparable information on disability in Europe • A research programme to list all the existing single questions, scientific material, survey data and analysis and make a proposal: • Need for a short-single question which intends to reflect the level & trends in disability in the EU populations, • To collect data on difficulties in daily activities, with no reference to specific age or people usual activities • To account for severity level being able to have both a large definition and a restricted one « Are you limited, for at leat the past 6 mounth, in activities people usaully do » Severely; To some extend; No, not limited • The question has been disseminated in Europe, being used in SILC and various national surveys (French and Belgian HIS)

  3. Who report “being limited”? • Such questions screen a selected part of the population, even among those who should be captured • Wording is important and orient the interpretation … is source of variability in understanding and inclination to report • Conclusions on level, trends, disparities depends on how people understand the question and who are the “limited” Research has to be conducted to better qualify the population reporting « limitations »

  4. Objectives of the study 1. To define the disability situations of people reporting GALI as regard to the disability conceptual framework 2. To assess the variability in self-report, according to various sociodemographic variables • We mobilise the various disability questions of the French-HIS and propose a “gold standard” defined on the basis of disablement process models • We analyse the specificity of the GALI referring to the “gold-standard” • We finally compare GALI in French-SILC and in the French-HIS

  5. Disability Alteration of the vision central Diseases Injuries Mal- formation body functions and activities Impair- ment Macular degenerescence Social disadvantage or Restriction of participation Disability concepts Difficulty to see small details Cannot drive Do not go out and visit friend Need help for daily shopping… • Different situations and needs… DEPENDENCY

  6. Social dis-advantage Disability Daily care, pension, Disability status, inactivity Functional limitations Activity Restrictions Activity Restrictions (Sensory, physical…) Diseases Injuries Mal- formation Daily assistance for personal care, pension… Difficulty or unable to care for him/herself, to care for accomodation, to work… Difficulty to see, to walk, to climb stairs… Assistive devices Accomodation… Functional limitations Assistive devices Accomodation… + Assistance + Daily care (Sensory, physical…) Disability measures: operationalization of the model GaLi ? • Construction of a GOLD-STANDARD to compare groups with/without GaLi Activity restriction Work, chore (no ADL-AR) Chronic conditions or compensated functional limitations (no consequences) Residual functional limitations (no activity restrictions) No ADL

  7. The French national health interview survey • French health interview survey 2002-2003 • 35 000 men and women / 26 000 adults (18 years and older) • Self-reported diseases, disability and medical consumption • Disability: various perceptions, various experiences, various needs • GaLi: self-perceived dysfuntions in activities • Self-reported work limitation due to health problems • Self-reported activity restriction (household / personal care activities) • Sensory and physical functional limitations

  8. Prevalence of GaLi, by sex and by age GaLi in the HIS 2002-003: description • 15% of the adult population report long term activity limitations • Women report more limitations than men at each age • Limitations increase with age

  9. Age-standardized prevalence of GaLi, by occupational status GaLi in the HIS 2002-003 : description • Significant inequalities with the population linked to occupational classes

  10. GaLi and other indicators, men and women 20+ GaLi in the HIS 2002-003 : description • More than twice as much diseases, occupational disruptions, disability status

  11. GaLi in the HIS 2002-003: Gold-standard • Does GALI capture people with disability / what type of disability? • Are people with « disability » captured GaLi? • Who is better captured by GaLi?

  12. Residual FL (no AR) AR (no ADL) Conditions or compensated FL (no consequences) No ADL 42% 15% 4% 23% 16% Women 16% 3% 20% 41% 21% Men 39% 15% 3% 30% 13% 4% 20% 21% 39% 15% GaLi in the HIS 2002-003: Gold-standard • Does GALI capture people with disability / what type of disability ? GaLi GaLi • People with GaLi mostly have significant functional problems • Activity limitations are mainly activity restriction • Good specificity: 95% have Funct pb / 92% have AR / 88% have ADL

  13. GaLi in the HIS 2002-003: Gold-standard • Are people with « disability » captured GALI? • among the 20 years+ with disability (1/3 of the population) • A number of persons with problems do not report being limited • mostly people with no activity restriction • Sensitivity improves with restriction severity and with age • among with Act Rest (20%) • among with ADL (4%) • Is GaLi well representative of people with disability?

  14. GaLi in the HIS 2002-003: Gold-standard • GaLi: Who is better captured ? Are more prone to report being limited : • Women compared to men • Elderly compared to younger people • Those who have or wait for administrative status (occupationally inactive people)

  15. GaLi in the French SILC versus GaLi in HIS • Exactly the same wording in EU-SILC 2004 • … but not the same answer categories: SILC deals with the severity level while HIS is a Yes/No cathegory • Much less people selected with the HIS-GaLi…

  16. GaLi in the French SILC versus GaLi in HIS • HIS-GaLi captures only a selection of the limited people compared to SILC, • The more answer categories the more people concerned • No mean to compare … BUT the selection could be more on the moderate level in France

  17. Summary GaLi description: • 15% of the adult population report being limited in France in 2003 • The prevalence increases with age • Women report more being limited than men do • Large social differences in limitations in defavor of manual occupations • GaLi goes along with more diseases, disability status, work problems GaLi vs Gold standard: • GaLi captures people with problems, mainly activity restrictions • GaLi captures half of the people reporting activity restrictions (75% for ADL) • GaLi better captures women, people with admi disability status, • … but no differences for education or occupation GaLi HIS vs GaLi SILC: • GaLi SILC might be more precise with distinction of the severity levels

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