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September 27, 2000

Quality of Life at the End of Life

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor

JAMA. 2000;284(12):1513-1515. doi:10.1001/jama.284.12.1512

To the Editor: Dr Liao and colleagues1 addressed the important issue of compression of morbidity by analyzing data from the 1986 and 1993 National Center for Health Statistics National Mortality Followback Surveys, and found an overall improvement in quality in the last year of life among persons aged 85 years and older.

Unfortunately, this work is flawed because of major methodological differences in the 2 surveys. First, the questions used to estimate prevalence of impairments in activities of daily living (ADLs) are strikingly different in the 2 surveys. Questions in 1986 asked about help or use of special equipment to perform ADLs, whereas those in 1993 asked whether the decedent had any difficulty performing these tasks. These are very different concepts and may provoke different responses, thus introducing bias into the results. For example, persons using special equipment to walk or bathe may not be perceived as having difficulty. A recent study shows that individuals respond very differently to these 2 types of questions.2

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