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Letters
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 report trends from 1986 to 1993 toward decreasing disability in the last year of life. However, they did not consider the important possibility that those trends are the result of widespread adoption of practices that permit an earlier death for those with progressive disability.

Figure 1 shows the 2 kinds of shifts that would result in less disability in the last year of life. The 1986 average experience could have improved from a type I shift toward better health and more frequent sudden death, which is what the authors assume to have happened. However, exactly the same trends would be found with a type II shift, with earlier deaths among those with substantial disability. As long as the effect on life span was small, on average, or as long as effects on average life span were obscured by general trends toward longevity, a type II shift would be completely inapparent in a last-year-of-life analysis.

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