Trajectories of Quality of Life in Older Persons with Advanced Illness

Authors

  • Rachel Solomon MD,

    1. From the *Department of Medicine, New York University School of Medicine, New York, New York; Psychiatry Service and #Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Department of Psychiatry, §Program on Aging, and Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
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  • Paul Kirwin MD,

    1. From the *Department of Medicine, New York University School of Medicine, New York, New York; Psychiatry Service and #Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Department of Psychiatry, §Program on Aging, and Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
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  • Peter H. Van Ness PhD, MPH,

    1. From the *Department of Medicine, New York University School of Medicine, New York, New York; Psychiatry Service and #Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Department of Psychiatry, §Program on Aging, and Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
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  • John O'Leary MA,

    1. From the *Department of Medicine, New York University School of Medicine, New York, New York; Psychiatry Service and #Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Department of Psychiatry, §Program on Aging, and Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
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  • Terri R. Fried MD

    1. From the *Department of Medicine, New York University School of Medicine, New York, New York; Psychiatry Service and #Clinical Epidemiology Research Center, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut; and Department of Psychiatry, §Program on Aging, and Department of Internal Medicine, School of Medicine, Yale University, New Haven, Connecticut.
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  • Presented at the 2007 annual meeting of the American Geriatrics Society.

Address correspondence to Terri Fried, MD, CERC 151B, VA Connecticut Healthcare System, 950 Campbell Avenue, West Haven, CT 06516. E-mail: terri.fried@yale.edu

Abstract

OBJECTIVES: To examine subjective ratings of quality of life (QoL) in older adults with advanced illness.

DESIGN: Observational cohort study with interviews at least every 4 months for up to 2 years conducted between December 1999 and December 2002.

SETTING: Participants' homes.

PARTICIPANTS: One hundred eighty-five community-dwelling individuals aged 60 and older with advanced cancer, heart failure, or chronic obstructive pulmonary disease.

MEASUREMENTS: Participants were asked how they would rate their overall QoL.

RESULTS: Of participants who died, 46% reported good or best possible QoL at their final interview, 21% reported improvement in QoL from their penultimate to final interview, and 39% reported no change. Forty-nine percent of participants reported two or more changes in the direction of their QoL trajectories (e.g., QoL improved then declined). As measured over time in a multivariable longitudinal regression analysis, greater activity of daily living disability (adjusted odds ratio (AOR)=0.85, 95% confidence interval (CI)=0.75–0.95) and depressed mood (AOR=0.42, 95%CI=0.27–0.66) were associated with poorer QoL, whereas better self-rated health (AOR=4.79, 95% CI=2.99–7.69) and having grown closer to one's church (AOR=1.99, 95% CI=1.17–3.39) were associated with better QoL.

CONCLUSION: Although declining QoL is not an inevitable consequence of advancing illness, individuals' ratings of QoL are highly variable over time, suggesting that temporary factors may influence subjective QoL. Functional status, depression, and connection to one's religious community are shared determinants of QoL.

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