title: Will-to-live and survival in a 10-year follow-up among older people.
abstract: BACKGROUND
  there is little research how older people's will-to-live predicts their survival.
  
  
  OBJECTIVE
  to investigate how many years home-dwelling older people wish to live and how this will-to-live predicts their survival.
  
  
  METHODS
  as a part of the Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study, 400 home-dwelling individuals aged 75-90 were recruited into a cardiovascular prevention trial in Helsinki. In 2000, a questionnaire about the wishes of their remaining life was completed by 283 participants. Participants were inquired how many years they would still wish to live, and divided into three groups according to their response: group 1: wishes to live <5 years, group 2: 5-10 years, group 3: >10 years. Mortality was confirmed from central registers during a 10-year follow-up. The adjusted Cox proportional hazard model was used to determine how will-to-live predicted survival.
  
  
  RESULTS
  in group 1 wishing to live less than 5 years, the mean age and the Charlson comorbidity index were the highest, and subjective health the poorest. There were no differences between the groups in cognitive functioning or feeling depressed. Mortality was the highest (68.0%) among those wishing to live <5 years compared with those wishing to live 5-10 years (45.6%) or over 10 years (33.3%) (P < 0.001). With group 1 as referent (HR: 1.0) in the Cox proportional hazard model adjusting for age, gender, Charlson comorbidity index and depressive feelings, HR for mortality was 0.66 (95% CI: 0.45-0.95) (P = 0.027) and 0.47 (95% CI: 0.26-0.86) (P = 0.011) in groups 2 and 3, respectively.
  
  
  CONCLUSIONS
  the will-to-live was a strong predictor for survival among older people irrespective of age, gender and comorbidities.
authors: Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland. helena.karppinen@helsinki.fi
authors: Helena
authors: H
authors: Karppinen
authors: Marja-Liisa
authors: ML
authors: Laakkonen
authors: Timo E
authors: TE
authors: Strandberg
authors: Reijo S
authors: RS
authors: Tilvis
authors: Kaisu H
authors: KH
authors: Pitkälä
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology* / Q000523:psychology*; D015331:Cohort Studies; D019317:Evidence-Based Medicine; D005260:Female; D005387:Finland; D005500:Follow-Up Studies; D005544:Forecasting; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013534:Survival / Q000502:physiology* / Q000523:psychology*; D014836:Volition / Q000502:physiology*