Quality of the last year of life of older adults: 1986 vs 1993

Context The population is aging and life expectancy is increasing, but whet her morbidity and disability late in life also increase is unknown. Objective To examine whether the use of health care services, disability an d 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 res ponse 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, rep resenting 1.5 and 1.6 million decedents aged 65 years and older. Main Outcome Measures Days of hospital or nursing home stays, number and le ngth of disability in 5 activities of daily living, duration of impairment in 3 measures of cognitive function, and an overall sickness score among in dividuals aged 65 through 84 years and those aged 85 years and older. Results Women used significantly fewer hospital and nursing home services i n the last year of life in 1993 vs 1986 (mean reduction, 3.3 nights for bot h 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 greater than or e qual to 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 livin g decreased from 62.5% in 1986 to 52.1% in 1993 (P<.01), and those with nor mal cognitive function increased from 50.3% to 56.2% (P<.05). Their mean ov erall sickness score decreased and quality-of-life improved. Among women ag ed 65 through 84 years, the number with normal cognitive function increased and the mean sickness score decreased, but those with at least 2 activitie s of daily living impairments increased and the overall quality of life dec lined. A similar pattern of change was found in the oldest-old men except t hat cognitive function worsened. Most parameters for men aged 65 through 84 years did not change significantly. Conclusions Men and women at least 85 years old in the US experienced a bet ter overall quality of life in the last year of life in 1993 than those in 1986. Most measures for men and women aged 65 through 84 years improved or did not change.