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The natural history of health-related quality of life: A 10-year cohort study

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by Heather M. Orpana, Nancy Ross, David Feeny, Bentson McFarland, Julie Bernier and Mark Kaplan

Abstract
Keywords
Findings
Authors
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Abstract

Background

Taking account of the impacts of institutionalization and death, this study describes the normative trajectories of health-related quality of life (HRQL) in Canada as individuals age from mid - to late life.

Methods

A nationally representative sample of 7,915 community-dwelling adults aged 40 and older in 1994/1995 was studied using 10 years of data from the longitudinal National Population Health Survey.  Growth curve models of HRQL over age were fitted to describe the evolution of HRQL.  Successive models were tested, first including only those living in a household throughout the entire period, then adding those who moved to an institution, and finally, including those who had died.   

Results

HRQL remained generally stable until approximately age 70, when it began to decline.  Excluding individuals when they were institutionalized, or ignoring the impact of death resulted in overly optimistic trajectories of HRQL in later years.

Interpretation

These results demonstrate the importance of following individuals into institutions and accounting for death in the production of realistic health estimates in aging populations.

Keywords

aging, health status, health surveys, life expectancy, longevity, longitudinal studies

Findings

In Canada, as in most developed countries, the average age of the population and life expectancies are increasing. The resulting demographic shift toward a population with a larger proportion of older adults has directed attention to understanding how health evolves among adults from mid- to later life. Whether the population is experiencing a compression of morbidity, with ill health being confined to the last few years before death, or an expansion of morbidity with the additional years of life lived with disease, disability and loss of quality of life, has implications for society as a whole and for the health care system. [Full text]

Authors

Heather M. Orpana (613-951-1650; Heather.Orpana@statcan.gc.ca) and Julie Bernier (613-951-4556; Julie.Bernier@statcan.gc.ca) are with the Health Information and Research Division at Statistics Canada, Ottawa, Ontario, K1A 0T6; Nancy Ross is with McGill University; David Feeny is with Kaiser Permanente Northwest; Bentson McFarland is with the Oregon Health and Science University; and Mark Kaplan is with Portland State University.