Terminal trajectories of functional decline in the long-term care setting
Journal
Journals of Gerontology - Series A Biological Sciences and Medical Sciences
Journal Volume
62
Journal Issue
5
Pages
531-536
Date Issued
2007
Author(s)
Abstract
Background. Little is known about the terminal trajectories of functional decline among long-term care (LTC) residents dying with different diseases. Methods. A retrospective cohort study was performed on 747 individuals aged 65 or older who died between January 1994 and December 2004 in a 675-bed LTC facility in Massachusetts. Three study groups were created: advanced dementia, n = 314 (42%); terminal cancer, n = 63 (8%); and organ failure (congestive heart failure and chronic obstructive pulmonary disease), n = 370 (50%). Quarterly scores of 7 activities of daily living (ADLs) during the last year of life derived from the Minimum Data Set were compared among the three groups. Each activity was rated from 0 to 4 (higher scores indicate more dependence; total range, 0-28). Results. The mean age of all individuals at death was 91 ± 6 (standard deviation) years. Functional decline was greatest during the last 3 months of life, but this decline was most precipitous in the terminal cancer and organ failure groups compared to the advanced dementia group. The mean change in ADL scores during the last year of life differed among the three groups (p < .001), with the greatest decline in the terminal cancer group (from initial score 13 to final score 25), followed by the organ failure group (13 to 22), and finally, the advanced dementia group (24 to 27). Conclusions. The terminal trajectories of functional decline among LTC residents vary by underlying diseases. An understanding of these trajectories may be useful to clinicians and families caring for LTC residents near the end of life. Copyright 2007 by The Gerontological Society of America.
SDGs
Other Subjects
aged; aging; article; cancer; chronic obstructive lung disease; cohort analysis; congestive heart failure; daily life activity; dementia; dying; female; functional assessment; functional disease; human; long term care; major clinical study; male; multiple organ failure; priority journal; retrospective study; scoring system; United States
Publisher
Oxford University Press
Type
journal article