Quality of the last year of life of older adults: 1986 vs 1993.

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Abstract
When people survive to old age, fear of death is often joined by fears of disability or institutionalization. Morbidity and disability before death have a tremendous impact on such persons, their families, and the health care delivery system. Health care use increases substantially as people draw closer to death.1 In 1993, 73% of all deaths in the United States occurred among persons 65 years and older and 23% among those 85 years and older.2 It is therefore important to have a clear description of the health status and quality of life before death for this population. The theory of compression of morbidity3 posits that most persons would survive to the end of their biologically endowed life span and die of natural causes. The prevalence of disability and the proportion of life lived with disability would therefore decrease. Although this may be an ideal personal goal that could also reduce the burden on the health care system, other commentators predict that in the face of continued increases in total life expectancy, an extension of the period of disability prior to death may be an inevitable consequence of living to an advanced age.4,5 United States residents may instead be living a longer life with worsening health.6

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