Titolo della tesi: Disability-free life expectancy of Italian older adults: trends, inequalities, and applications
Italy's ageing population may pose challenges to the sustainability of the country's socioeconomic and healthcare systems. This depends on the (un)healthy ageing process. The disability status of mid-to-older adults is a crucial determinant of individuals' autonomy and participation in society. Disability-free life expectancy (DFLE) is an important metric for assessing the health and disability risks of the population in a summary indicator, neat of the age structure. Demographic changes also affect intergenerational relationships and in Italy, where grandparents play a significant role in caregiving, it is crucial to study their health evolution. This thesis aims to, first, detect the long-term trend of DFLE in Italy and to analyse the drivers of its change in terms of disability-specific mortality and dynamics of disability onset and recovery. Second, to shed light on gender, socioeconomic, and territorial inequalities in DFLE (and their intersections) and the factors driving these inequalities in terms of differences in mortality and disability risks. Third, to analyse the trend of the length of life to live as grandparents free from disability and understand how it is influenced by age-specific survival and grandparenthood-disability prevalence evolution.
The thesis applies different demographic and statistical methods to different cross-sectional and longitudinal data and provides DFLE estimates, trends and applications for mid-to-older Italian men and women. The findings show that while DFLE at mid-to-older ages has increased, it has not always progressed as favourably as life expectancy. The greatest contribution to DFLE changes is the changes in the transition in and out of disability. There are notable differences in DFLE at older ages within the country, between genders and educational groups. Women have a life expectancy advantage, but their health disadvantage counterbalances it. The disadvantage in DFLE accumulates over education and region of residence, resulting in higher educated living in northern regions having more than double DFLE than lower educated living in southern regions. Health differences are also the major contributors to educational differences in DFLE. Italian grandmothers and grandfathers are gaining years of coexistence-life-time with their grandchildren in good functional health. Women can expect to live more years as disability-free grandmothers than men, but their share of disability-free grandmothers years over total years as grandmothers is lower than that for men. The increase in disability-free grandparenthood years is primarily led by improved survival and health conditions and, for men, by the postponement of grandparenthood to older ages.