Quality of the Last Year of Life of Older Adults: 1986 vs 1993

• Published in: JAMA : the journal of the American Medical Association 2000-01, Vol.283 (4), p.512-518
• Main Authors: Liao, Youlian, McGee, Daniel L, Cao, Guichan, Cooper, Richard S
• Format: Article
• Language: English
• Subjects: Activities of Daily Living; Aged; Aged, 80 and over; Biological and medical sciences; Cognition; Disabled Persons; Female; Geriatric Assessment; Geriatrics - trends; Homes for the Aged - statistics & numerical data; Hospitalization - statistics & numerical data; Humans; Longevity; Male; Medical sciences; Morbidity; Nursing Homes - statistics & numerical data; Older people; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life; Sex Distribution; Specific populations (family, woman, child, elderly...); United States
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.283.4.512

CONTEXT The population is aging and life expectancy is increasing, but whether morbidity and disability late in life also increase is unknown. OBJECTIVE To examine whether the use of health care services, disability and cognitive function, and overall quality of life in the year before death among older adults has changed over time. DESIGN AND SETTING The 1986 and 1993 National Mortality Followback Surveys, which were probability samples of all deaths in the United States with response rates of next of kin of 90% and 88% for those aged 65 years and older. PARTICIPANTS Next of kin were asked to report the health status of a total of 9179 decedents who were 65 years and older in 1986 and 6735 in 1993, representing 1.5 and 1.6 million decedents aged 65 years and older. MAIN OUTCOME MEASURES Days of hospital or nursing home stays, number and length of disability in 5 activities of daily living, duration of impairment in 3 measures of cognitive function, and an overall sickness score among individuals aged 65 through 84 years and those aged 85 years and older. RESULTS Women used significantly fewer hospital and nursing home services in the last year of life in 1993 vs 1986 (mean reduction, 3.3 nights for both age groups for hospital services; mean reduction 18.4 nights for nursing home for women aged 65-84 years and 42.3 nights for women ≥85 years). Men had no changes except those aged 85 years and older had a decline in nursing home nights of 32.6. The proportion of women aged 85 years and older with restriction of at least 2 activities of daily living decreased from 62.5% in 1986 to 52.1% in 1993 (P