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September 27, 2000

Quality of Life at the End of Life—Reply

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

In Reply: Dr Lentzner points out some specific methodological changes that occurred between the 1986 and 1993 surveys. A principal strength of these data sets is still the consistency of the major design. The changes in wording of ADL questionnaires would be expected to lead to an increase, rather than a decrease, in reporting of the presence of disabilities. In 1986, the respondents were asked to list all hospitals and nursing homes in which the decedent stayed during the last year. The total nights of stay were then estimated. In 1993, length of stay was estimated immediately after listing each facility. This small change in data acquisition procedures is unlikely to introduce the observed large decline in usage among many groups and has no influence on the estimation of the prevalence of nonusers. Bias due to a shift in method would be expected to systematically affect all age groups. However, significant favorable changes in many indicators were found in persons aged 85 years and older but not in the younger age group. We also conducted analyses adjusting for modes of interview (telephone, personal, or mail). This adjustment did not materially change the results.

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