From Disability to Death: A 20-Year Follow-Up from the Taiwan Longitudinal Study on Aging

Abstract

Background

In this study, factors associated with the duration of a disability before death in older adults who are moderately to severely disabled in Taiwan are investigated.

Methods

A nationally representative sample of older adults (65+) in 1996 who died before 2016 (n = 1139) were analyzed to calculate their disability status and the length of time they were disabled before death.

Results

The mean period during which the participants experienced moderate to severe disability before death for older adults in Taiwan was 5.53 years (SD = 3.15). Men who were overweight had an average of 1.17 more survival years (β_overweight = 1.17, p < 0.05) as compared to those who were normal weight, and in the case of those who were cognitively impaired (SPMSQ ≤ 7), years of survival were decreased by an average of 1.70 years as compared to those who were cognitively intact before death (βcognition = −1.70, p < 0.01). The aforementioned effects were independent of age. In women, the number of diseases was the most dominant independent correlate for survival years (β_disease = −0.34, p < 0.05).

Conclusion

Disability distribution at various time points before death among the elderly in Taiwan was revealed in the study. At 10 years before death, 93% of the elderly were free from any ADL disabilities, and only 4% reported more than three ADL disabilities. At 6 years before death, an average of 10% of the participants had more than three ADL disabilities, and at one year before death, moderate to severe disability increased to 38%. Factors associated with the survival years among those who were moderately to severely disabled showed distinct gender differences.

Keywords:

• disability
• duration before death
• elderly
• risk factor

Acknowledgments

We are grateful to the Health Data Science Center, National Cheng Kung University Hospital for providing administrative and technical support.

Abbreviations

BMI, body mass index; TLSA, Taiwan Longitudinal Study on Aging; ADL, Activities of Daily Living; SPMSQ, Short Portable Mental Status Questionnaire; CES-D, Center for Epidemiologic Studies Depression Scale.

Data Sharing Statement

The data that support the findings of this study are available from Health Data Science Center, but restrictions apply to the availability of these data, which were used under license for the current study, and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of the Health Data Science Center.

Ethics Approval and Consent to Participate

This study was approved by the Institutional Review Board (IRB) of National Cheng Kung University Hospital in Taiwan (No. B-ER-104-077) and informed consent was waived.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests.