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Accelerated Dysfunction Among the Very Oldest-Old in Nursing Homes

^a Institute of Gerontology, University of Michigan, Ann Arbor
^b School of Public Health, University of Michigan, Ann Arbor
^c Ann Arbor VA Medical Center, Michigan
^d Hebrew Rehabilitation Center for Aged, Boston, Massachusetts
^e Geriatrics Center, University of Michigan Medical Center, Ann Arbor
^f Department of Nursing Home Medicine, Vrije Universiteit, Amsterdam, The Netherlands

Correspondence: Brant E. Fries, Institute of Gerontology, University of Michigan, 300 North Ingalls, Ann Arbor, MI 48109-2007 E-mail: [email protected].

William B. Ershler, MD

Background. The population aged 65 and older is often analyzed in three categories: young-old (65–74), middle-old (75–84), and oldest-old (85). This may blind heterogeneity within the oldest category. New, large data sets allow examination of the very oldest-old (e.g., aged 95) and contrasts with those who are younger.

Methods. We determined the annual change of prevalence of physical and cognitive function, and of disease problems in the old to very oldest-old, using data from existing Resident Assessment Instrument records from nursing homes in seven states during 1992–1994. We used data from 193,467 unique residents aged 80 or older, including 6,556 residents aged 100 or older. We computed the prevalence, by age, of selected conditions: physical and cognitive function, diseases, problem behavior, mood disturbance, restraint use, falls, weight loss, eating less, body mass index, chewing and swallowing problems, incontinence (bowel and bladder), catheter use, and selected diagnoses.

Results. Prevalence of all measures of physical and cognitive dysfunction increased most rapidly with each year of age among the very oldest-old. Most of the slope changes occurred from 95 to 100 years of age. Such changes are less pronounced or not seen in measures of disease prevalence.

Conclusions. Accelerated change in prevalence of dysfunction seen in the nursing home population may suggest a change in the mechanisms of aging that occur after the mid-nineties. Examination of the very oldest-old may provide new insight into the nature of the aging process.