General Practice and Primary Care Research Unit, University of Cambridge, Cambridge, United Kingdom.
J Am Geriatr Soc. 2010 Jan;58(1):1-11. doi: 10.1111/j.1532-5415.2009.02622.x.
To characterize people of advanced old age in their last year of life and compare those dying in their late 80s with those dying aged 90 and older to inform policy and planning.
Retrospective analysis of prospectively collected population-based data from the Cambridge City over-75s Cohort (CC75C) Study, United Kingdom.
Men and women aged 85 and older at death who died less than 1 year after taking part in any CC75C survey (N=321).
Physical health, functional disability, self-rated health, cognitive status.
Functional and cognitive impairments were markedly higher for those who died aged 90 and older- predominantly women-than for those who died aged 85 to 89. At least half (49.4-93.6%) of subjects aged 90 and older needed maximum assistance in virtually every daily activity; those aged 85 to 89 needed this only for shopping and laundry. Disability in basic and instrumental activities rose from 59.1% before to 85.4% after the age of 90 and cognitive impairment (Mini-Mental State Examination score < or =21) from 41.7% to 69.4%. Despite this and proximity to death, 60.5% and 67.0%, respectively, rated their health positively. Only one in five reported needing more help.
This study provides new data identifying high levels of physical and cognitive disability in very old people in the year before death. As the very old population rises, so will support needs for people dying in extreme old age. The mismatch between health perceptions and functional limitations suggests that these vulnerable older adults may not seek help from which they could benefit. These findings have major policy and planning implications for end-of-life care for the oldest old.
描述生命最后一年高龄老人的特征，并将 80 多岁末期死亡者与 90 岁及以上死亡者进行比较，为政策和规划提供信息。
对英国剑桥市 75 岁以上人群队列研究（CC75C）前瞻性收集的人群数据进行回顾性分析。
在任何一次 CC75C 调查时年龄为 85 岁及以上且在参与调查后 1 年内死亡的男性和女性（N=321）。
身体健康、功能障碍、自我评估健康状况、认知状态。
与 85 至 89 岁死亡者相比，90 岁及以上死亡者（主要为女性）的功能和认知障碍明显更严重。至少有一半（49.4-93.6%）的 90 岁及以上者在几乎所有日常活动中都需要最大程度的帮助；而 85 至 89 岁者仅在购物和洗衣时需要这种帮助。基本和工具性活动的残疾率从 90 岁前的 59.1%上升到 90 岁后的 85.4%，认知障碍（简易精神状态检查评分≤21）从 41.7%上升到 69.4%。尽管如此，且接近死亡，仍分别有 60.5%和 67.0%的人对自己的健康状况评价良好。只有五分之一的人表示需要更多帮助。
本研究提供了新的数据，表明生命最后一年高龄老人的身体和认知障碍程度很高。随着超高龄人口的增加，极端高龄死亡者的支持需求也将增加。健康认知与功能障碍之间的不匹配表明，这些脆弱的老年人可能不会寻求他们可能受益的帮助。这些发现对为最年长老人提供临终关怀的政策和规划具有重大意义。
