Disability during the last two years of life.

TitleDisability during the last two years of life.
Publication TypeJournal Article
Year of Publication2013
AuthorsSmith, AK, Walter, LC, Miao, Y, W Boscardin, J, Covinsky, KE
JournalJAMA Intern Med
Date Published2013 Sep 09
ISSN Number2168-6114
KeywordsActivities of Daily Living, Aged, Aged, 80 and over, Disability Evaluation, Disabled Persons, Educational Status, Female, Frail Elderly, Humans, Income, Longitudinal Studies, Male, Marital Status, Middle Aged, Prospective Studies, Sex Distribution, Socioeconomic factors, United States

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.


Copyright - Copyright American Medical Association Sep 9, 2013 Last updated - 2013-09-18 SubjectsTermNotLitGenreText - United States--US

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Endnote Keywords

Medical Sciences/Older people/Disability/Disability/Palliative care/Aging/United States--US

Endnote ID


Alternate JournalJAMA Intern Med
Citation Key7789
PubMed ID23836120
PubMed Central IDPMC3773297
Grant ListR01 CA134425 / CA / NCI NIH HHS / United States
UL1 RR024131 / RR / NCRR NIH HHS / United States
1K23AG040772-01A1 / AG / NIA NIH HHS / United States
K24AG029812 / AG / NIA NIH HHS / United States
K23 AG040772 / AG / NIA NIH HHS / United States
K24 AG041180 / AG / NIA NIH HHS / United States
K24 AG029812 / AG / NIA NIH HHS / United States
1K24AG041180-01 / AG / NIA NIH HHS / United States
P30 AG044281 / AG / NIA NIH HHS / United States