Trajectories of Disability in the Last Year of Life

Bibliographic Data

ID23348296
AuthorsThomas M Gill (0000-0002-6450-0368, Yale University), Evelyne A Gahbauer (Yale University), Ling Han (0000-0002-3088-0374, Yale University), Heather Allore (0000-0001-7685-8175, Yale University), Heather G Allore
Year2010
Volume362
Issue13
Pages1173-1180
Publication date2010-04-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueNew England Journal of Medicine (JOURNAL)
Journal identifiersISSN: 0028-4793 • E-ISSN: 1533-4406
PublisherMassachusetts Medical Society (PUBLISHER • US)
DOI10.1056/nejmoa0909087
PMID20357280
PMCIDPMC2877372
OpenAlexW2158938545
LanguageEN
Citations received57
References cited26

BACKGROUND: Despite the importance of functional status to older persons and their families, little is known about the course of disability at the end of life. METHODS: We evaluated data on 383 decedents from a longitudinal study involving 754 community-dwelling older persons. None of the subjects had disability in essential activities of daily living at the beginning of the study, and the level of disability was ascertained during monthly interviews for more than 10 years. Information on the conditions leading to death was obtained from death certificates and comprehensive assessments that were completed at 18-month intervals after the baseline assessment. RESULTS: In the last year of life, five distinct trajectories were identified, from no disability to the most severe disability: 65 subjects had no disability (17.0%), 76 had catastrophic disability (19.8%), 67 had accelerated disability (17.5%), 91 had progressive disability (23.8%), and 84 had persistently severe disability (21.9%). The most common condition leading to death was frailty (in 107 subjects [27.9%]), followed by organ failure (in 82 subjects [21.4%]), cancer (in 74 subjects [19.3%]), other causes (in 57 subjects [14.9%]), advanced dementia (in 53 subjects [13.8%]), and sudden death (in 10 subjects [2.6%]). When the distribution of the disability trajectories was evaluated according to the conditions leading to death, a predominant trajectory was observed only for subjects who died from advanced dementia (67.9% of these subjects had a trajectory of persistently severe disability) and sudden death (50.0% of these subjects had no disability). For the four other conditions leading to death, no more than 34% of the subjects had any of the disability trajectories. The distribution of disability trajectories was particularly heterogeneous among the subjects with organ failure (from 12.2 to 32.9% of the subjects followed a specific trajectory) and frailty (from 14.0 to 27.1% of the subjects followed a specific trajectory). CONCLUSIONS: In most of the decedents, the course of disability in the last year of life did not follow a predictable pattern based on the condition leading to death.

Dementia · Disease · Longitudinal study · Chronic Disease Management Strategies · Frailty in Older Adults · Internal Medicine · Medicine · Palliative Care and End-of-Life Issues · Gerontology

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