title: Functional impairment, race, and family expectations of death.
abstract: OBJECTIVE
  To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race.
  
  
  METHODS
  Cross-sectional.
  
  
  METHODS
  Community based.
  
  
  METHODS
  Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older.
  
  
  METHODS
  Families were interviewed within 2 years of the HRS participant's death. The primary outcome was whether death was expected. The primary predictors were the decedent's functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent's race.
  
  
  RESULTS
  Overall, 58% of families reported that their family member's death was expected. Expecting death was strongly associated with functional impairment; 71% of families of decedents with ADL disability expected death, compared with 24% of those without ADL disability (P < .01). Death was expected more often in families of white decedents (60%) than African Americans (49%) (P < .01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR) = 3.58, 95% confidence interval (CI) 2.73-4.70), and families of African Americans expected death less often than families of white decedents (OR = 0.63, 95% CI = 0.46-0.86).
  
  
  CONCLUSIONS
  Family members of older adults expected death only 58% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites.
authors.affiliation: Division of Geriatrics, University of California at San Francisco, San Francisco, California, USA. brie.williams@ucsf.edu
authors.forename: Brie A
authors.initials: BA
authors.lastname: Williams
authors.forename: Karla
authors.initials: K
authors.lastname: Lindquist
authors.forename: Sandra Y
authors.initials: SY
authors.lastname: Moody-Ayers
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
mesh_terms: D000203:Activities of Daily Living; D001741:Black or African American / Q000523:psychology; D000368:Aged; D001293:Attitude to Death / Q000208:ethnology*; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000706:statistics & numerical data; D005190:Family / Q000208:ethnology / Q000523:psychology*; D005260:Female; D006630:Hispanic or Latino / Q000523:psychology; D006801:Humans; D008297:Male; D044465:White People / Q000523:psychology