• Alexander K Smith, Louise C Walter, Yinghui Miao, W John Boscardin, and Kenneth E Covinsky.
• Division of Geriatrics, Department of Medicine, University of California, San Francisco2Veterans Affairs Medical Center, San Francisco, California.
• JAMA Intern Med. 2013 Sep 9;173(16):1506-13.

ImportanceWhereas 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.ObjectiveTo determine national estimates of disability during the last 2 years of life.DesignProspective cohort study.SettingA nationally representative study of older adults in the United States.ParticipantsParticipants 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 MeasuresDisability 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.ResultsThere 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 RelevanceThose 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.

20 keywords...

hide…