Global Activity Limitations
Contact: Dorly Deeg
In the Disablement Process model, functional limitations precede disability. The former concept refers to difficulty with or inability to perform actions such as walking, but do not necessarily impede activities in daily life. The latter concept refers to limitations in activities or roles, such as (house)work, caregiving, or leisure activities (Verbrugge and Jette 1994). For the former, it is referred to the documentation ‘Functional limitations’.
Measurement instruments in LASA
In order to measure activity limitations, four questions were adapted from the medical outcome study short form general health survey (Stewart et al 1988).
The first question is: ‘Do health problems limit your daily activities?’ with response options: 1) no, 2) yes, somewhat, 3) yes, very much. Importantly this question is able to distinguish mild from severe disability (as perceived by the respondent). In case options 2 or 3 were reported, the next questions was asked: ‘How long have health problems limited your daily activities?’, with response options: 1) more than 3 months or 2) less than 3 months. If the response to this second question is ‘more than 3 months’, the respondent can be classified as having long-standing activity limitations.
Two other questions were asked to all respondents: ‘How many days during the past month did you have to stay in bed due to (an) illness?’ and ‘How many days during the past month were you unable to do your daily activities due to (an) illness?’ For these two questions, response options were 1) none, 2) 1–3 days, 3) 4–7 days, 4) >1 week, <1 month, 5) all of the time.
The first question was also included in the telephone interviews with respondents from wave C onwards. Because the second question was not asked, it may be questionable to use the telephone interview data to indicate long-standing activity limitations of more than 3 months. To illustrate, in wave H (2011-2012) 2.6% reported limitations that lasted shorter than 3 months, and in wave I (2015-2016), this percentage was 2.2%. The total percentage of mild and severe limitations that lasted 3 months or longer was 42.0% in wave H and 38.0% in wave I. In comparison, the 2-3% of respondents who reported limitations lasting for less than 3 months is very low. It is up to the researcher to weigh the gain of a more representative sample through the inclusion of telephone data against the loss of precision in measuring long-standing activity limitation.
LASAB033 / LASAC033 / LASAD033 / LASAE033 / LAS2B033 / LASAF033 / LASAG033 / LASAH033 / LAS3B033 / LASAI033 / LASAJ033 / LASAK033 (main interview: in Dutch);
LASAC703 / LASAD703 / LASAE703 / LASAF703 / LASAG703 / LASAH703 / LASAI703 / LASAJ703 / LASAK703
(telephone interview with RESP, in Dutch)
LASAB033 / LASAC033 / LASAD033 / LASAE033 / LAS2B033 / LASAF033 / LASAG033 / LASAH033 / LAS3B033 / LASAI033 / LASAJ033 / LASAK033 (K not available yet)
LASAC703 / LASAD703 / LASAE703 / LASAF703 / LASAG703 / LASAH703 / LASAI703 / LASAJ703 / LASAK703 (K not available yet)
Availability of information per wave 1
1 More information about the LASA data collection waves is available here.
* 2B=baseline second cohort;
3B=baseline third cohort;
MB=migrants: baseline first cohort;
K=not available yet
Ma=data collected in main interview;
Tr=data collected in telephone interview with respondent
Correspondence with the EU Global Activity Limitations Indicator (GALI)
The Global Activity Limitation Indicator (GALI) was developed by the International Network on Health Expectancy and the Disability Process (REVES = Reseau Espérance de Vie en Santé), with the aim of providing a simple indicator that could be included in international datasets with a main focus on topics other than health, for example, on income and living conditions. Development criteria were, amongst others: reference to long-standing activity limitations, i.e. a duration of at least 6 months; reference to a general health problem, including both physical and/or mental health; reference to activities people usually do rather than to activities the respondent usually does, so as to preclude that respondents reported less limitation because they had adapted their activities due to limitations; inclusion of at least three response levels so as to distinguish mild from severe limitation (Van Oyen et al 2006).
The resulting one-item question was: ‘For at least the last 6 months, have you been limited because of a health problem in activities people usually do?’ with 3 response categories: 1) Yes, strongly limited; 2) Yes, limited; 3) No, not limited.
The GALI has been translated in the languages of EU-countries, is part of the Minimum European Health module, and has been included in the European Union – Statistics on Income and Living Conditions (EU-SILC) as of 2004. In spite of the efforts to harmonize the exact wording across all EU countries, differences in wording remain. In 2008, a major effort towards harmonization was made. Up to then, in the Dutch SILC the wording was: ‘Are you limited in your daily activities by health problems?’. This wording was very close to the wording in LASA. In 2008, however, this was changed to: ‘To what extent did you, during the past 6 months and due to health problems, experience limitations in activities that people usually do?’ (EHLEIS 2015). The change resulted in a noticeable increase in the prevalence of activity limitations (EHLEIS 2018).
Since the beginning of LASA, a very close version of the GALI has been included. The first two questions combined indicate long-standing activity limitation. Yet, differences exist in the minimum duration of the limitation and in the type of activities referred to. Regarding the duration, when an individual has a limitation for as long as 3 months, it is not likely to be a short-term problem, and it will likely last for 6 months. A more serious difference between the standard GALI question and the LASA-question is that the LASA-question refers to ‘your daily activities’ and not to ‘activities people usually do’. This may mean that the LASA-question leads to underreporting of limitations, and thus to a lower prevalence of activity limitations. In fact, the wording of the LASA-question is more similar to that of the initial GALI-question when it was first included in the Dutch EU-SILC. As the change in wording in 2008 led to a clear increase in the prevalence of activity limitations for men and women between 2007 and 2008 in the Netherlands (EHLEIS 2018), it may be that the LASA-question represents some underreporting.
Previous use in LASA
The GALI has been used to calculate healthy life expectancy across European countries (Robine et al 2013). By analogy, healthy working life expectancy was calculated based in the GALI in three successive cohorts in LASA (van der Noordt et al 2019). The findings showed that between 1992 and 2016, not only did the number of years in the work force increase, but also the number of years in the workforce with disability. The robustness of findings was checked by repeating the analyses using functional limitations items based on self-report and a performance-based test of physical functioning.
Other LASA-studies used the GALI and the next two questions among several indicators to define disability (van Gool et al 2005) or among determinants of the outcome longevity (Deeg et al 2018).
- Deeg D, Kardaun J, van der Noordt M, Hoogendijk E, van Schoor N. Towards better prediction of individual longevity. Netspar Design Paper 111, November 2018.
- EHLEIS (European Health & Life Expectancy Information System). Health questions from the Minimum European Health Module used in EU-SILC in the 27 EU countries. EHLEIS Technical report 2015_TR4.5.
- EHLEIS (European Health & Life Expectancy Information System). Country Reports Issue 11. EHLEIS Technical report 2018_4.1. (eurohex.eu)
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- Robine, J.-M., E. Cambois, W. Nusselder, B. Jeune, H. Van Oyen, C. Jagger en het JA: EHLEIS team. The Joint Action on Healthy Life Years (JA: EHLEIS). Archives of Public Health 2013; 71: 2.
- Stewart A, Hays R, Ware J. The Medical Outcome Study short form general health survey. Medical Care 1988; 26: 724–733.
- van der Noordt M, van der Pas S, van Tilburg TG, van den Hout A, Deeg DJH. Changes in working life expectancy with disability in the Netherlands, 1992–2016. Scand J Work Environ Health 2019; 45(1): 73-80.
- van Gool CH, Kempen GIJM, Penninx BWJH, Deeg DJH, Beekman ATF, Van Eijk JTM. Impact of depression on disablement in late middle aged and older persons: results from the Longitudinal Aging Study Amsterdam. Social Science and Medicine 2005; 60: 25-36.
- Van Oyen H, Van der Heyden J, Perenboom R, Jagger C. Monitoring population disability: evaluation of a new Global Activity Limitation Indicator (GALI). Soz Praventiv Med 2006; 51: 153–161.
- Verbrugge LM, Jette AM. The disablement process. Social Science & Medicine 1994; 38(1): 1–14.
Date of last update: July, 2020 (first version)