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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.

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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

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