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Studies Address Living Longer, Chronic Illness At End Of Life

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MAY 18, 1998 VOLUME 5, NUMBER 46

With improvements in medical care, nutrition and sanitation, we have steadily lengthened life for most seniors. It has been less clear, however, whether the quality of life has been improved at the same time.

In this youth-oriented culture, the image of aging is frequently tied to chronic illness and debility. Two recent studies attempt to determine whether longer life can mean better life, and whether chronic illness can be linked to shortened life expectancy.

In a study conducted by researchers at Stanford University, college graduates were followed for a 30-year period to determine whether longer life could be equated with disability. Subjects of the study were analyzed for disabilities twenty years after college graduation (at an average age of 43) and again several times over the next thirty-two years. They hoped to determine whether those subjects who died at older ages were chronically ill for longer or shorter periods at the end of their lives.

Not surprisingly, the researchers found that those subjects who smoked, avoided exercise and were overweight all tended to die younger. Ranges were assigned to those three risk factors, and each subject was categorized as high risk, moderate risk or low risk based on their smoking, exercise and weight.

Not only did the low-risk group tend to live longer, they also suffered fewer disabilities during the last year and two years of their lives. Among the subjects who died during the study period, the high-risk group showed about twice the level of disabilities found in their low-risk colleagues.

Similarly, among the study participants who were still living at the end of the reported data period (at an average age of 75 years) the low-risk group was in substantially better health. Again, they were about half as likely to suffer disabling conditions as their high-risk peers. New England Journal of Medicine, 4/9/98.

The Stanford study supports the so-called “compression of morbidity” hypothesis. According to that theory, health improvements which increase longevity should increase the average age of onset of disability even more dramatically. In other words, lengthening life should also improve the quality of life, on average.

A second recent study, conducted by Yale researchers, looked at a related issue. Do demented patients, or patients who are unable to perform activities of daily living without assistance, tend to die more quickly than their more independent peers?

To determine the answer, all patients over age 70 admitted to Yale’s hospital for a three-week period were evaluated. They were given cognitive tests and evaluated for functional disabilities (such as limitations on their ability to feed, clothe or bathe themselves, or to use the telephone, cook or handle finances). Their vision and hearing were also checked, as was their susceptibility to depression.

Among the patients with cognitive deficits, the risk of death within two years was almost three times that of patients without dementia. For patients with functional deficits, the risk of death within two years was about doubled. There were also slight increases in the risk of death for those with vision or hearing losses and for those suffering from depression. Journal of the American Medical Association, 4/15/98.

Of course, it is easy to observe that dementia, functional limitations and other health problems are more likely to appear in patients who are sicker on admission to the hospital (and thus less likely to survive). This undoubtedly accounts for some of the increase in mortality for those patients. Still, researchers attempted to correct for this bias, and the study shows a strong correlation between functional and mental status and risk of death.

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Robert B. Fleming


Robert Fleming is a Fellow of both the American College of Trust and Estate Counsel and the National Academy of Elder Law Attorneys. He has been certified as a Specialist in Estate and Trust Law by the State Bar of Arizona‘s Board of Legal Specialization, and he is also a Certified Elder Law Attorney by the National Elder Law Foundation. Robert has a long history of involvement in local, state and national organizations. He is most proud of his instrumental involvement in the Special Needs Alliance, the premier national organization for lawyers dealing with special needs trusts and planning.

Robert has two adult children, two young grandchildren and a wife of over fifty years. He is devoted to all of them. He is also very fond of Rosalind Franklin (his office companion corgi), and his homebound cat Muninn. He just likes people, their pets and their stories.

Elizabeth N.R. Friman


Elizabeth Noble Rollings Friman is a principal and licensed fiduciary at Fleming & Curti, PLC. Elizabeth enjoys estate planning and helping families navigate trust and probate administrations. She is passionate about the fiduciary work that she performs as a trustee, personal representative, guardian, and conservator. Elizabeth works with CPAs, financial professionals, case managers, and medical providers to tailor solutions to complex family challenges. Elizabeth is often called upon to serve as a neutral party so that families can avoid protracted legal conflict. Elizabeth relies on the expertise of her team at Fleming & Curti, and as the Firm approaches its third decade, she is proud of the culture of care and consideration that the Firm embodies. Finding workable solutions to sensitive and complex family challenges is something that Elizabeth and the Fleming & Curti team do well.

Amy F. Matheson


Amy Farrell Matheson has worked as an attorney at Fleming & Curti since 2006. A member of the Southern Arizona Estate Planning Council, she is primarily responsible for estate planning and probate matters.

Amy graduated from Wellesley College with a double major in political science and English. She is an honors graduate of Suffolk University Law School and has been admitted to practice in Arizona, Massachusetts, New York, and the District of Columbia.

Prior to joining Fleming & Curti, Amy worked for American Public Television in Boston, and with the international trade group at White & Case, LLP, in Washington, D.C.

Amy’s husband, Tom, is an astronomer at NOIRLab and the Head of Time Domain Services, whose main project is ANTARES. Sadly, this does not involve actual time travel. Amy’s twin daughters are high school students; Finn, her Irish Red and White Setter, remains a puppy at heart.

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Matthew M. Mansour


Matthew is a law clerk who recently earned his law degree from the University of Arizona James E. Rogers College of Law. His undergraduate degree is in psychology from the University of California, Santa Barbara. Matthew has had a passion for advocacy in the Tucson community since his time as a law student representative in the Workers’ Rights Clinic. He also has worked in both the Pima County Attorney’s Office and the Pima County Public Defender’s Office. He enjoys playing basketball, caring for his cat, and listening to audiobooks narrated by the authors.