title: Trajectories of quality of life in older persons with advanced illness.
abstract: OBJECTIVE
  To examine subjective ratings of quality of life (QoL) in older adults with advanced illness.
  
  
  METHODS
  Observational cohort study with interviews at least every 4 months for up to 2 years conducted between December 1999 and December 2002.
  
  
  METHODS
  Participants' homes.
  
  
  METHODS
  One hundred eighty-five community-dwelling individuals aged 60 and older with advanced cancer, heart failure, or chronic obstructive pulmonary disease.
  
  
  METHODS
  Participants were asked how they would rate their overall QoL.
  
  
  RESULTS
  Of participants who died, 46% reported good or best possible QoL at their final interview, 21% reported improvement in QoL from their penultimate to final interview, and 39% reported no change. Forty-nine percent of participants reported two or more changes in the direction of their QoL trajectories (e.g., QoL improved then declined). As measured over time in a multivariable longitudinal regression analysis, greater activity of daily living disability (adjusted odds ratio (AOR)=0.85, 95% confidence interval (CI)=0.75-0.95) and depressed mood (AOR=0.42, 95%CI=0.27-0.66) were associated with poorer QoL, whereas better self-rated health (AOR=4.79, 95% CI=2.99-7.69) and having grown closer to one's church (AOR=1.99, 95% CI=1.17-3.39) were associated with better QoL.
  
  
  CONCLUSIONS
  Although declining QoL is not an inevitable consequence of advancing illness, individuals' ratings of QoL are highly variable over time, suggesting that temporary factors may influence subjective QoL. Functional status, depression, and connection to one's religious community are shared determinants of QoL.
authors.affiliation: Department of Medicine, New York University School of Medicine, New York, New York, USA.
authors.forename: Rachel
authors.initials: R
authors.lastname: Solomon
authors.forename: Paul
authors.initials: P
authors.lastname: Kirwin
authors.forename: Peter H
authors.initials: PH
authors.lastname: Van Ness
authors.forename: John
authors.initials: J
authors.lastname: O'Leary
authors.forename: Terri R
authors.initials: TR
authors.lastname: Fried
mesh_terms: D000368:Aged; D015331:Cohort Studies; D017281:Cost of Illness; D003863:Depression; D005260:Female; D006333:Heart Failure; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009369:Neoplasms; D029424:Pulmonary Disease, Chronic Obstructive; D011788:Quality of Life; D012067:Religion
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