”It`s important to be able to recognize a decline in health in the elderly, a decline in vitality at an early point,” he says. ”The evidence Focus, for a moment, on this unsettling image: the final year of your life. Perhaps you`ll be hacking your way happily around the golf course at 80. Or maybe you`ll be studying for that master`s degree you always wanted. Then again, you might be in a nursing home, or not that bad off but still infirm or confused, sadly dependent on others.
But just how many old people remain ”fully functional” at age 82, the average life span for those who were 65 in 1987? How many end up ”severely restricted?” And what if there are better ways to control the quality of your life up to the end?
The federal Centers for Disease Control has taken a first look at those questions on the way to tackling a bigger challenge, one that carries great personal and social significance as America`s elderly population explodes:
successful aging.
”Practically every older person you talk to says, `I don`t want to live to be 95 if I have to spend the last five years of my life in a nursing home,”` says Dr. Harold Lentzner, lead author of the report, ”The Quality of Life in the Year Before Death,” published this month in the American Journal of Public Health.
Not only are our lives getting longer, but the 65-and-over age group is growing much faster than the nation as a whole. And the oldest of the elderly- those 85 and above-make up the fastest-growing age group in Florida, the nation`s oldest state, according to the 1990 Census.
The study looked at the final year of a nationally representative sample of 7,500 people over age 64 who died in 1986. Researchers described various levels of physical and mental competence, then categorized each individual in several areas. Information was gathered from interviews with family members and friends, and from records such as death certificates.
What the researchers found was that only 14 percent of them were ”fully functional” in their last year of life, while 10 percent were ”severely restricted.” Fully functional was defined as needing no help in five activities of daily living-eating, bathing, dressing, walking and using the toilet. Also, those defined as fully functional were lucid until a few days before death and had spent less than a week in a hospital or nursing home.
Those considered ”severely restricted” needed help or special equipment for six months or more before death in at least three of the daily living activities. They also exhibited a decline in mental functioning and spent at least half their last year in a hospital or nursing home.
The study found that in the last year of life:
– Women were about 40 percent less likely than men to have been fully functional, and 70 percent more likely to have been severely restricted. This supports other research that while women live longer than men, they are more apt to be impaired.
– Being unmarried doubled the chances of being severely restricted.
– Dying of anything other than a heart attack sharply reduced the chance of being fully functional.
– Those fully functional were less likely to have ever smoked, abused alcohol or abstained from alcohol.
– The quality of life dropped dramatically with age. While 20 percent of those who died between 65 and 74 were considered fully functional, only 6 percent remained so among the oldest group, those 85 or older. That oldest group also was more than twice as likely as the youngest group to have mental limitations.
By the year 2000, the study concludes, the number of people age 85 and over who will be severely restricted in their final months may increase 50 percent.
”Think about the costs unless we do something about that,” Lentzner says. ”The country is going to be spending an astounding amount of money dealing with elderly folks in their last year of life.”
Joyce Hamann, program administrator for Aging and Adult Services of Broward County, Fla., says the study may be able to help social and health workers target and attack risk factors for people as they age.
”We`re looking more and more in Florida in expanding the kinds of services available to people so they can stay at home longer, perhaps until they die,” she says.
Lentzner says that`s one way the study can be used.
”It`s important to be able to recognize a decline in health in the elderly, a decline in vitality at an early point,” he says. ”The evidence suggests that intervention at an early time can postpone adverse effects.”
But Hamann also says it`s significant that information on which the study is based came not directly from the people being studied, since they had died, but from the people closest to them.
”You wonder what these individuals themselves would have said about their quality of life,” she says. ”It might be quite different from their family`s perception.”
Lentzner, an epidemiologist with the National Center for Chronic Disease Prevention and Health Promotion in Atlanta, emphasizes that the study was not an attempt to label people or judge their quality of life.
