Tuesday, March 9, 2010

Myths of the golden years

While our government debates this bill:
Mere misery now reason for mercy killing
National Post
A federal private member's bill to legalize euthanasia and assisted suicide, C-384, is expected to come up for a vote in Parliament within weeks


The GeriPal blog posts about a study in the Journal of the American Geriatrics Society by researchers at the University of Cambridge that examines functional status during the last year of life in the very old.
The study illustrates a point we have recently stressed on GeriPal: The vast majority of older persons will have some degree of significant disability in the last years of life. This is in contrast to the popular perception that disability can be prevented if one does all the right things. Encouraging good health habits is a very good thing. However, suggesting that if you become disabled, it must be because you did something wrong is a very bad thing.

The last year of life in the oldest-old

There is a very interesting study in the January issue of the Journal of the American Geriatrics Society that characterizes functional status during the last year of life in the very old. The study illustrates a point we have recently stressed on GeriPal: The vast majority of older persons will have some degree of significant disability in the last years of life. This is in contrast to the popular perception that disabiity can be prevented if one does all the right things. Encouraging good health habits is a very good thing. However, suggesting that if you become disabled, it must be because you did something wrong is a very bad thing.

This clever study, led by Jun Zhao of the University of Cambridge in the United Kingdom, leveraged the Cambridge City Over 75 Cohort Study. This longstanding study originally enrolled a representative sample of persons over age 75 and has been following them for over 2 decades. This analysis examined the 321 subjects who died after the age of 85, who had interviews in the last year of life. On average, these subjects were interviewed 6 months before death. Because these 321 subjects are broadly representative of older decedants in Cambridge, the results provide important insights about the functional status of persons over age 85 in the last year of life. Here are some key selected findings:

In the last year of life, the overwhelming majority of persons over the age of 85 have major functional impairments. Among those age 85-89, in the last year:
  • 50% of persons needed the help of another person to bathe
  • 30% needed the help of another person to shower
  • Only 43% could walk one block, and only 19% could walk around town
  • 57% needed help preparing meals
  • 76% needed help doing housework
  • 86% needed help shopping
  • 34% needed help taking their medicines
  • Putting this all together, 59% were disabled in basic activities of daily living (ADL). 26% could do all their ADL independently, but needed help with instrumental activities of daily living (IADL). Only 15% did not have disability in ADL or IADL. (note: ADL refer to basic activities essential to living independently such as bathing or dressing. If one is disabled in ADL, one generally can not live successfully without help. IADL refer to higher ordered activities important to well being such as housework or meal prep)
Rates of late life disability escalate markedly as people approach their 90's. It is rare for persons in their 90's to not have major disability in their last year of life. For example:
  • 56% of persons needed help getting dressed
  • 76% needed help bathing
  • 90% needed help preparing meals
  • 87% needed help with housework
  • 97% needed help shopping
  • 64% needed help taking medicines
  • Only 6% could walk about town. Only 22% could walk one block
  • Putting this all together, 85% had a disability in a basic activity of daily living (ADL). 11% were independent in ADL, but had a disability in an instrumental activity of daily living (IADL). Only 3% (ie, about 1 in 30), were free of disability in either ADL or IADL.

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