Accelerated dysfunction among the very oldest-old in nursing homes

Background. Tnt:population aged 65 and older is often analyzed in three cat egories: young-old (65-74), middle-old (75-84), and oldest-old (greater tha n or equal to 85). This may blind heterogeneity within the oldest category. New, large data sets allow examination of the very oldest-old (e.g., aged greater than or equal to 95) and contrasts with those who are younger. Methods. We determined the annual change of prevalence of physical and cogn itive function, and of disease problems in the old to very oldest-old, usin g data from existing Resident Assessment instrument records from nursing ho mes in seven states during 1992-1994. We used data from 193,467 unique resi dents aged 80 or older, including 6,556 residents aged 100 or older. We com puted the prevalence. by age, of selected conditions: physical and cognitiv e function, diseases. problem behavior, mood disturbance, restraint use, fa lls, weight loss, eating less, body mass index, chewing and swallowing prob lems, incontinence (bowel and bladder), catheter use, and selected diagnose s. Results. Prevalence of all measures of physical and cognitive dysfunction i ncreased most rapidly with each year of age among the very oldest-old. Most of thr slope changes occurred from 95 to 100 years of age. Such changes ar e less pronounced or not seen in measures of disease prevalence. Conclusions. Accelerated change in prevalence of dysfunction seen in the nu rsing home population may suggest 4 change in the mechanisms of aging that occur after the mid-nineties. Examination of the very oldest-old may provid e new insight into the nature of the aging process.