Four Patterns in End-of-Life Decline? - Summary - MDSpire
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Four Patterns in End-of-Life Decline?
International cohort study found physical function declined most rapidly before mortality, while socioeconomic status was associated with more favorable multidomain trajectories.
To analyze the trajectories of physical, cognitive, and psychological functioning during the final decade of life and identify patterns of decline among decedents.
Approach:
Data Sources: Investigators analyzed harmonized longitudinal data from the US Health and Retirement Study, the China Health and Retirement Longitudinal Study, and the Survey of Health, Ageing and Retirement in Europe involving 79,305 adults aged 45 years or older.
Assessment Methods: Physical functioning was assessed using activities of daily living, cognitive functioning tests, and psychological functioning using validated depressive symptom scales.
Analysis: The study examined the trajectory of three functional domains during the decade preceding mortality and identified multidomain co-decline patterns.
Key Findings:
Decedents experienced steeper declines in physical, cognitive, and psychological functioning compared to survivors.
Physical functioning showed the greatest deterioration, with declines accelerating as mortality approached.
Four distinct patterns of decline were identified among decedents: mild decline, preserved physical and psychological functioning with cognitive decline, declining physical functioning with cognitive and psychological decline, and rapidly declining physical functioning with low and worsening cognitive and psychological functioning.
Higher socioeconomic status was associated with a lower likelihood of experiencing the most unfavorable trajectory.
Interpretation:
Limitations:
Physical and psychological functioning relied on self-reported assessments.
Functional measures differed across cohorts, requiring statistical harmonization.
Exact mortality dates were unavailable for some participants and were imputed.
Assessments conducted every 2 to 3 years may not have captured finer changes near the end of life.
The multidomain trajectory analysis included only decedents with at least three repeated measurements, limiting generalizability.
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