Around a quarter of all older people have disability during the last 2 years of life, with prevalence higher among women and those aged over 80 years

Context The rapidly growing number of disabled elderly is expected to tax health delivery systems, whose focus has been the management of disease rather than the prevention and management of disability. The burden of caring for the disabled rests largely with family caregivers, who commonly experience physical and emotional strain. The network of community services designed to assist caregivers is fragmented, variable and costly. The activity of daily living (ADL) disability may be especially high among individuals near the end of life. Methods To determine the prevalence of disability in the 2 years preceding death, the authors used data from the Health and Retirement Study (HRS), a longitudinal study of health and wealth in a nationally representative sample of US adults aged 50 and over. The HRS surveyed participants every 2 years and determined the date of death in 99 of those involved. From a sample of 8232 decedents between 1995 and 2010, the authors estimated the national prevalence of disability in the last 24 months of life using restricted cubic spline models. The final spline model was entered into a multivariate regression to estimate the probability of disability in various subgroups. Findings At 24 months before death, the predicted prevalence of disability ranged from 15 for those aged 50 69 to 50 among those aged 90. Regardless of the starting prevalence of disability, the four age groups (50 69, 70 79, 80 89 and 90 ) showed similar linear rates of increase from 24 months to around 9 months before death, after which the prevalence of disability rose sharply. At all points in time women were more disabled than men.

Disability/Disability/Health delivery systems/Activities of daily living/MORTALITY/Prevalence/Gender

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