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The advantages and challenges of disability-free survival as outcome measure in clinical studies

Nature Aging volume 5, pages 721–722 (2025)Cite this article

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This Correspondence describes the advantages and challenges of using disability-free survival (DFS) as an outcome measure in large-scale prevention trials conducted in older populations. Its relevance is based on the steady increase in the proportion of older individuals in most healthcare systems. According to the World Health Organization, the global population aged 65 years and older is expected to nearly double by 2050 to reach over 1.5 billion individuals, around 16% of the global population. This demographic shift has profound implications that will reshape many of the priorities of medical care and the medical research agenda.

DFS (also referred to as ‘healthy life years’) has been well established for more than a decade in daily geriatric care, and also as an outcome measure in epidemiological studies; it is now widely used in establishing national health targets1. In the European Union, disability-free life expectancy has been used since 2005 to set targets for various health initiatives. A common approach to measuring DFS has been through responses to the global activity limitation indicator, based on responses to a single question2.

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Author information

Authors and Affiliations

  1. Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia

    Johannes T. Neumann

  2. Department of Cardiology, University Heart & Vascular Centre Hamburg, Hamburg, Germany

    Johannes T. Neumann

  3. German Centre for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Hamburg, Germany

    Johannes T. Neumann & John J. McNeil

Authors
  1. Johannes T. Neumann
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  2. John J. McNeil
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Corresponding author

Correspondence to Johannes T. Neumann.

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Competing interests

J.T.N. reports honoraria from Abbott, PHC, Roche and Siemens outside the submitted work.

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Nature Aging thanks Kenneth Rockwood and the other, anonymous, reviewer(s) for their contribution to the peer review of this work.

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Neumann, J.T., McNeil, J.J. The advantages and challenges of disability-free survival as outcome measure in clinical studies. Nat Aging 5, 721–722 (2025). https://doi.org/10.1038/s43587-025-00853-x

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