Abstract:
IMPORTANCE:Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life. OBJECTIVE:To determine national estimates of disability during the last 2 years of life. DESIGN:Prospective cohort study. SETTING:A nationally representative study of older adults in the United States. PARTICIPANTS:Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex. MAIN OUTCOMES AND MEASURES:Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet. RESULTS:There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52% women). The prevalence of disability increased from 28% (95% CI, 24%-31%) 2 years before death to 56% (95% CI, 52%-60%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14%; 70-79 years, 21%; 80-89 years, 32%; 90 years or more, 50%; P for trend, <.001). Disability was more common in women 2 years before death (32% [95% CI, 28%-36%]) than men (21% [95% CI, 18%-25%]; P < .001), even after adjustment for older age at death. CONCLUSIONS AND RELEVANCE:Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.
journal_name
JAMA Intern Medjournal_title
JAMA internal medicineauthors
Smith AK,Walter LC,Miao Y,Boscardin WJ,Covinsky KEdoi
10.1001/jamainternmed.2013.8738subject
Has Abstractpub_date
2013-09-09 00:00:00pages
1506-13issue
16eissn
2168-6106issn
2168-6114pii
1710125journal_volume
173pub_type
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