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.
To determine national estimates of disability during the last 2 years of life.
Prospective cohort study.
A nationally representative study of older adults in the United States.
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.
Main Outcomes and Measures
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.
There were 8232 decedents (mean [SD] age at death, 79  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 and Relevance
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.