Trajectories of Disability in the Last Year of Life

• Published in: The New England journal of medicine Vol. 362; no. 13; pp. 1173 - 1180
• Main Authors: Gill, Thomas M, Gahbauer, Evelyne A, Han, Ling, Allore, Heather G
• Format: Journal Article
• Language: English
• Published: Waltham, MA Massachusetts Medical Society 01.04.2010
• Subjects: Activities of Daily Living; Aged, 80 and over; Bayes Theorem; Biological and medical sciences; Cause of Death; Disability; Disability Evaluation; Disease Progression; Ethics; General aspects; Humans; Hypotheses; Longitudinal Studies; Medical sciences; Older people; Persons with Disabilities - statistics & numerical data; Public health. Hygiene; Public health. Hygiene-occupational medicine; Studies; Teaching. Deontology. Ethics. Legislation; Disability; Medicine; End of life
• ISSN: 0028-4793; 1533-4406; 1533-4406
• DOI: 10.1056/NEJMoa0909087

This longitudinal study involving older adults identified five trajectories during the last year of life: no disability, catastrophic disability, accelerated disability, progressive disability, and persistently severe disability. Most of the subjects who died suddenly had no disability, and most of those who died from advanced dementia had persistently severe disability; however, the course of disability was not predictable for the majority of the subjects, who died from other causes. This longitudinal study involving older adults identified five trajectories during the last year of life: no disability, catastrophic disability, accelerated disability, progressive disability, and persistently severe disability. The course of disability was not predictable for the majority of the subjects. According to the hypothesis of a compression of morbidity, if the onset of disability could be postponed, then lifetime disability could be compressed into a shorter average period before death. 1 Supporting this hypothesis, data from several large national surveys have shown a decline in disability rates that exceeds the observed decline in mortality. 2 , 3 Although informative at the population level, these results may not be directly relevant to individual patients, their families, or their physicians, who may be more interested in knowing the likelihood and course of disability at the end of life. Previous research has shown that the majority . . .