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

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 (beta(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 (beta(cognition) = -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 (beta(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.