Disability Prior to Death Among the Oldest-Old in China

Abstract

Background: To estimate the prevalence of disability during the last 3 years prior to death among the oldest-old (≥80 years) in China.

Methods: We used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS), a nationally representative study of the oldest-old in China. The analytic sample included 23,934 decedents who died between 1998 and 2014 and had at least one interview within the last 3 years of life. Disability was defined as being incontinent or needing assistance in performing one or more of five other essential activities (bathing, transferring, dressing, eating, and toileting).

Results: About 57.8% (weighted) of the study decedents were female. The prevalence of disability increased modestly from 36 months to 24 months prior to death (20% to 23%), more rapidly from 24-months to 12-months before death (23% to 31%), and substantially from 12 months before death to the last month of life (31% to 48%). The disability rates were lowest for participants who died between 80 and 89 years, intermediate for those who died between 90 and 99 years, and highest for those who died at age 100 or older, although the patterns over the 3-year period were comparable for the three age groups. At each time point prior to death, a higher percentage of women was disabled than men.

Conclusions: In this large nationally representative sample of the oldest-old in China, the prevalence of disability during the 3 years prior to death is high and is greater in women than men and those who die at the oldest ages.

Figure 1.

Prevalence of ADL (activities of daily living) and severe ADL disability during the last 3 years of life. Solid line represents ADL disability, and dashed line represents severe ADL disability. Gray shading above and below the line represents modeled 95% confidence intervals. Severe ADL disability was defined as needing assistance with three or more ADL tasks. Disability prevalence was modeled as a spline with knots at 30, 16, and 4 months prior to death, adjusting for sociodemographic factors including age at death, sex, race/ethnicity, education, lifetime primary occupation, economic independence, being in receipt of adequate drugs for any illnesses, current marital status, co-residence with adult children, regular exercise, currently consuming alcohol, and calendar time term.

Figure 2.

Prevalence of ADL (activities of daily living) disability during the last 3 years of life by age at death and sex. (A) age at death 80–89 years; (B) 90–99 years; and (C) ≥100 years. Solid line represents men, and dashed line represents women. Gray shading above and below the line represents modeled 95% confidence intervals. Disability prevalence was modeled as a spline with knots at 30, 16, and 4 months prior to death, adjusting for sociodemographic factors including age at death, sex, race/ethnicity, education, lifetime primary occupation, economic independence, being in receipt of adequate drugs for any illnesses, current marital status, co-residence with adult children, regular exercise, currently consuming alcohol, and calendar time term.