Volume 54, Issue 11 p. 1682-1687

Functional Impairment, Race, and Family Expectations of Death

Brie A. Williams MD

Brie A. Williams MD

From the Division of Geriatrics, University of California at San Francisco, San Francisco, California

San Francisco VA Medical Center, San Francisco, California.

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Karla Lindquist MS

Karla Lindquist MS

From the Division of Geriatrics, University of California at San Francisco, San Francisco, California

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Sandra Y. Moody-Ayers MD

Sandra Y. Moody-Ayers MD

From the Division of Geriatrics, University of California at San Francisco, San Francisco, California

San Francisco VA Medical Center, San Francisco, California.

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Louise C. Walter MD

Louise C. Walter MD

From the Division of Geriatrics, University of California at San Francisco, San Francisco, California

San Francisco VA Medical Center, San Francisco, California.

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Kenneth E. Covinsky MD

Kenneth E. Covinsky MD

From the Division of Geriatrics, University of California at San Francisco, San Francisco, California

San Francisco VA Medical Center, San Francisco, California.

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First published: 18 October 2006
Citations: 9
Address correspondence to Brie A. Williams, MD, 4150 Clement Street Box 181-G, San Francisco, CA 94121. E-mail: [email protected]

Abstract

OBJECTIVES: To assess the effect of functional impairment on family expectations of death and to examine how this association varies by race.

DESIGN: Cross-sectional.

SETTING: Community based.

PARTICIPANTS: Two thousand two hundred thirty-seven family members of decedents from the Health and Retirement Survey (HRS), a national study of persons aged 50 and older.

MEASUREMENTS: Families were interviewed within 2 years of the HRS participant's death. The primary outcome was whether death was expected. The primary predictors were the decedent's functional status (impairment in any activity of daily living (ADL; eating, dressing, transferring, toileting, or bathing) during the last 3 months of life and the decedent's race.

RESULTS: Overall, 58% of families reported that their family member's death was expected. Expecting death was strongly associated with functional impairment; 71% of families of decedents with ADL disability expected death, compared with 24% of those without ADL disability (P<.01). Death was expected more often in families of white decedents (60%) than African Americans (49%) (P<.01), although the effect of ADL disability was similar in both groups. After adjustment for potentially confounding factors, there were still significant associations between expecting death and functional impairment (odds ratio (OR)=3.58, 95% confidence interval (CI) 2.73–4.70), and families of African Americans expected death less often than families of white decedents (OR=0.63, 95% CI=0.46–0.86).

CONCLUSION: Family members of older adults expected death only 58% of the time. Families of functionally impaired older people were more likely to expect death when it occurred than were families of older people who were not functionally impaired, and the expectation of death was lower for families of African Americans than for whites.