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

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.

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.

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).

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.