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Terminal decline in physical function in older adults
Article
BACKGROUND: It is currently unclear whether (and when) physical function exhibits a terminal decline phase, i.e. a substantial acceleration of decline in the very last years before death.
METHODS: 702 deceased adults aged 70 years and older from the Yale PEP Study provided 4,133 measurements of physical function (Short Physical Performance Battery, SPPB) up to 20 years before death. In addition, continuous gait and chair rise sub-test scores (in seconds) were assessed. Generalized mixed regression models with random change points were used to estimate the onset and the steepness of terminal decline in physical function.
RESULTS: Decline accelerated in the last years of life in all three measures of physical function. The onset of terminal decline occurred at 1 year before death for the SPPB, and at 2.5 and 2.6 years before death for chair rise and gait speed test scores, respectively. Terminal declines in physical function were 6-8 times steeper than pre-terminal declines. Relative to those whose condition leading to death was frailty, participants who died from dementia and cancer had an up to 6 months earlier and 3 months later onset of terminal decline in SPPB, respectively.
CONCLUSION: Terminal decline in physical function among older adults is comparable to the more established terminal decline phenomenon in cognition. Our results provide additional evidence of late-life rapid decline in physical function due to impending death.
http://dx.doi.org/10.1093/gerona/glad119
Voir la revue «The journals of gerontology. Series A, biological sciences and medical sciences»
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