Helena Karppinen1,2, Marja-Liisa Laakkonen1,3, Timo E. Strandberg4,5, Reijo S. Tilvis6 and Kaisu H. Pitkälä1,2

Author Affiliations: 1Unit of General Practice, Helsinki University Central Hospital, Helsinki, Finland; 2Department of General Practice and Primary Health Care, University of Helsinki, Helsinki, Finland;3Helsinki Health Centre, Laakso Hospital, Helsinki, Finland; 4Department of Health Sciences/Geriatrics, University of Oulu, Oulu, Finland; 5Unit of General Practice, Oulu University Hospital, Oulu, Finland;6Clinics of General Internal Medicine and Geriatrics, Helsinki University Central Hospital, Helsinki, Finland


Background: there is little research how older people's will-to-live predicts their survival.

Objective: to investigate how many years home-dwelling older people wish to live and how this will-to-live predicts their survival.

Methods: as a part of the Drugs and Evidence-Based Medicine in the Elderly (DEBATE) study, 400 home-dwelling individuals aged 75–90 were recruited into a cardiovascular prevention trial in Helsinki. In 2000, a questionnaire about the wishes of their remaining life was completed by 283 participants. Participants were inquired how many years they would still wish to live, and divided into three groups according to their response: group 1: wishes to live <5 years, group 2: 5–10 years, group 3: >10 years. Mortality was confirmed from central registers during a 10-year follow-up. The adjusted Cox proportional hazard model was used to determine how will-to-live predicted survival.

Results: in group 1 wishing to live less than 5 years, the mean age and the Charlson comorbidity index were the highest, and subjective health the poorest. There were no differences between the groups in cognitive functioning or feeling depressed. Mortality was the highest (68.0%) among those wishing to live <5 years compared with those wishing to live 5–10 years (45.6%) or over 10 years (33.3%) (P < 0.001). With group 1 as referent (HR: 1.0) in the Cox proportional hazard model adjusting for age, gender, Charlson comorbidity index and depressive feelings, HR for mortality was 0.66 (95% CI: 0.45–0.95) (P = 0.027) and 0.47 (95% CI: 0.26–0.86) (P = 0.011) in groups 2 and 3, respectively.

Conclusion: the will-to-live was a strong predictor for survival among older people irrespective of age, gender and comorbidities.