Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2018 Feb;33(2):177-181.
doi: 10.1007/s11606-017-4232-6. Epub 2017 Dec 4.

Three Year Functional Trajectories Among Old Age Survivors and Decedents: Dying Eliminates a Racial Disparity

June R Lunney  1 , Steven M Albert  2 , Robert Boudreau  3 , Diane Ives  3 , Suzanne Satterfield  4 , Anne B Newman  3 , Tamara Harris  5 ; Health ABC study
Affiliations
Multicenter Study

Three Year Functional Trajectories Among Old Age Survivors and Decedents: Dying Eliminates a Racial Disparity

June R Lunney et al. J Gen Intern Med. 2018 Feb.

Abstract

Background: Long-term trajectories of disability comparing decedents and survivors and differences by race have not been assessed.

Objective: To examine self-reported difficulty in walking a quarter mile and the need for assistance with activities of daily living (ADL) beginning 3 years before death among decedents and age- and gender-matched survivors.

Design: A case-control sample drawn from the Health, Aging and Body Composition Study (Health ABC). Data were collected between 1997 and 2015.

Participants: Of the 1991 participants who died by the end of the study, 1410 were interviewed for 3 years prior to death, including an interview 6 months before dying. Of these, 1379 decedents were successfully matched by age and gender with 1379 survivors and tracked over the same 3-year period.

Main measures: Self-reported difficulty walking a quarter mile and the ability to perform activities of daily living without assistance (bathing, dressing, transferring).

Key results: Decedents (mean age at death, 84) increased in mobility disability from 44.1% 3 years before death to 69.4% 6 months before death and in ADL disability from 32.9% to 58.4%. Among survivors, mobility disability increased from 31.4% to 40.7% and ADL disability from 17.4% to 31.4%. The proportion of decedents and survivors with mobility disability differed significantly in adjusted models at all assessment points (p < 0.0001). African-American survivors were significantly more disabled than White survivors at all points (p < 0.0001), but trajectories of disability among decedents did not differ by race in the last 18 months of life (p = 0.35).

Conclusions: Trajectories of self-reported disability differ between survivors and decedents. Older adults who died were more disabled 3 years before death and also had a greater risk of increasing disability over each subsequent 6-month assessment. The gap in disability between African Americans and Whites was erased in the final 1 to 1.5 years before death.

Keywords: disability mobility; end of life; functional decline; racial disparities.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they do not have a conflict of interest.

Figures

Figure 1
Figure 1
Ability to walk a quarter mile without difficulty by vital status and race
Figure 2
Figure 2
Ability to perform activities of daily living without assistance by vital status and race
See this image and copyright information in PMC

Comment in

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Carey EC, Walter LC, Lindquist K, Covinsky KE. Development and validation of a functional morbidity index to predict mortality in community-dwelling elders. J Gen Intern Med. 2004;19(10):1027–33. doi: 10.1111/j.1525-1497.2004.40016.x. - DOI - PMC - PubMed
    1. Inouye SK, Peduzzi PN, Robison JT, Hughes JS, Horwitz RI, Concato J. Importance of functional measures in predicting mortality among older hospitalized patients. JAMA. 1998;279(15):1187–93. doi: 10.1001/jama.279.15.1187. - DOI - PubMed
    1. Schonberg MA, Davis RB, McCarthy EP, Marcantonio ER. Index to predict 5-year mortality of community-dwelling adults aged 65 and older using data from the National Health Interview Survey. J Gen Intern Med. 2009;24(10):1115–22. doi: 10.1007/s11606-009-1073-y. - DOI - PMC - PubMed
    1. Hennessy S, Kurichi JE, Pan Q et al. Disability stage is an independent risk factor for mortality in Medicare beneficiaries aged 65 years and Older. PM R. 2015;7(12):1215-25. - PMC - PubMed
    1. Dunlop DD, Song J, Manheim LM, Daviglus ML, Chang RW. Racial/ethnic differences in the development of disability among older adults. Am J Public Health. 2007;97(12):2209–15. doi: 10.2105/AJPH.2006.106047. - DOI - PMC - PubMed

Publication types