Stephen J.LurieMD, PhD, Senior EditorIndividualAuthorPhil B.FontanarosaMD, Executive Deputy EditorIndividualAuthor
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.
Lynn J. Quality of Life at the End of Life. JAMA. 2000;284(12):1513-1515. doi:10.1001/jama.284.12.1512