Modern medicine and biomedical technologies allow for longer lifespans, and many people in their 80s and 90s continue to live independently. Alexander K. Smith, from the University of California/San Francisco (UCSF; California, USA), and colleagues examined the prevalence of disability with age. The researchers analyzed data collected on 8,232 subjects who participated in the Health and Retirement Study (HRS), an ongoing longitudinal study of changes in health and wealth in people older than 50. Disability was defined as requiring assistance with any of six activities of daily living (ADL), namely – dressing, bathing, eating, getting in or out of bed, walking across a room, and using the toilet. The prevalence of disability increased significantly during the last 2 years of life. At 24 months prior to death, 46% of the participants had difficulty with an ADL, 28% had a disability, and 12% had a severe disability. By the last month of life, the numbers were 68%, 56%, and 40%, respectively. Further, the team found that severe disability increased more than difficulty with AD, with the increase in severe disability at its steepest during the last 6 months of life. Most of the participants had difficulty with walking and stair climbing. Two years before death, 69% of participants had difficulty walking several blocks, 45% walking one block, 82% climbing several flights of stairs, 53% climbing one flight of stairs, 22% managing finances, and 14% taking medications. A month before death, the proportion of participants who had difficulty with the same activities increased to 85%, 68%, 91%, 72%, 45%, and 32%. Disability was significantly more common among people who died at the most advanced ages. The prevalence of disability among people 90 or older increased from 50% 2 years before death to 59% at 12 months, and to 77% in the last month of life. Among people who were younger than 70 at death, disability was at least 35% lower at any point during the last 24 months of life. The study authors warn that: “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.”
