title: Disability during the last two years of life.
abstract: OBJECTIVE
  Whereas many persons at advanced ages live independently and are free of disability, we know little about how likely older people are to be disabled in the basic activities of daily living that are necessary for independent living as they enter the last years of life.
  
  
  OBJECTIVE
  To determine national estimates of disability during the last 2 years of life.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  A nationally representative study of older adults in the United States.
  
  
  METHODS
  Participants 50 years and older who died while enrolled in the Health and Retirement Study between 1995 and 2010. Each participant was interviewed once at a varying time point in the last 24 months of life. We used these interviews to calculate national estimates of the prevalence of disability across the 2 years prior to death. We modeled the prevalence of disability in the 2 years prior to death for groups defined by age at death and sex.
  
  
  METHODS
  Disability was defined as need for help with at least 1 of the following activities of daily living: dressing, bathing, eating, transferring, walking across the room, and using the toilet.
  
  
  RESULTS
  There were 8232 decedents (mean [SD] age at death, 79 [11] years; 52% women). The prevalence of disability increased from 28% (95% CI, 24%-31%) 2 years before death to 56% (95% CI, 52%-60%) in the last month of life. Those who died at the oldest ages were much more likely to have disability 2 years before death (ages 50-69 years, 14%; 70-79 years, 21%; 80-89 years, 32%; 90 years or more, 50%; P for trend, <.001). Disability was more common in women 2 years before death (32% [95% CI, 28%-36%]) than men (21% [95% CI, 18%-25%]; P < .001), even after adjustment for older age at death.
  
  
  CONCLUSIONS
  Those who live to an older age are likely to be disabled, and thus in need of caregiving assistance, many months or years prior to death. Women have a substantially longer period of end-of-life disability than men.
authors.affiliation: Division of Geriatrics, Department of Medicine, University of California, San Francisco2Veterans Affairs Medical Center, San Francisco, California.
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smith
authors.forename: Louise C
authors.initials: LC
authors.lastname: Walter
authors.forename: Yinghui
authors.initials: Y
authors.lastname: Miao
authors.forename: W John
authors.initials: WJ
authors.lastname: Boscardin
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Covinsky
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007182:Income; D008137:Longitudinal Studies; D008297:Male; D017533:Marital Status; D008875:Middle Aged; D011446:Prospective Studies; D017678:Sex Distribution; D012959:Socioeconomic Factors; D014481:United States / Q000453:epidemiology