{Background}: While widely studied as a feature of old age, the gender paradox (that women live longer but are in poorer health) in the period prior to death has received far less attention. Here, we endeavor to determine whether that paradox persists in the last years of very long lives. {Methods}: One hundred and eighty-six participants in the Swiss Interdisciplinary Longitudinal Study on the Oldest Old (Swilsoo) were interviewed up to eight times before their death. Gender, age at death, socio-occupational category and urban/rural residence were analysed as potential factors predisposing to end life with ADL-dependence, using a negative binomial regression. {Results}: On average, participants were ADL-dependent 1.67 years before death. In univariate analyses, periods of pre-mortem ADL-dependence were found to be longer with increasing age at death, for women, for the rural elderly and for those of lower socio-occupational categories. However, for the same age at death, women did not suffer longer from pre-mortem ADL-dependence than men. {Discussion}: The gender paradox continues into the last years of long lives and is primarily due to the differential longevity between women and men. Very old women suffer from great inequalities, perhaps the greatest they encounter in their life course.