Commentary on "Disability Trajectories at the End of Life: A Countdown Model" The Problems With Time-to-Death as a Predictor of Disability.
Commentary on "Disability Trajectories at the End of Life: A Countdown Model" The Problems With Time-to-Death as a Predictor of Disability.
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DOI：
10.1093/geronb/gbv001
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发表时间：
2015-09
期刊：
影响因子：
--
通讯作者：
Lynch SM
中科院分区：
文献类型：
--
作者：
Lynch SM
对生命末期残疾轨迹的研究既有趣又重要。每个人都会死亡，大多数成年人都活到了高龄，在死前他们经历了一定程度的身体衰退。这段衰退期显然与我们个人有关，但也与社会有关，社会最终通过联邦医疗保险和医疗补助支出承担了大部分医疗保健的财政负担。因此，了解晚年的残疾过程是很重要的。特别是像“晚期死亡”和“晚期衰退”这样的概念是有意义的，因为如果我们能够认识到谁可能经历哪种类型的模式，我们可能就能够开发干预措施来提高死亡质量，我们也许能够更好地预测临终支出。沃尔夫等人最近的论文。出于这些原因是耐人寻味的。简而言之，作者使用死亡时间(TTD)作为残疾轨迹的预测指标。关键目标是确定死亡之前的残疾轨迹的数量和形状，最终估计那些经历晚期下降、晚期衰退和其他模式的人的流行率。虽然我认为方法很有趣，而且当然是一丝不苟的，但作为TTD的函数来研究残疾轨迹有两个关键问题，在使用这种方法时应该谨慎。首先，将TTD视为先于TTD的残疾模式的预测因子，混淆了因果关系的方向。其次，作者建议的方法不能提供比不混淆因果关系方向的模型更有用的信息。
The study of disability trajectories at the end of life is both interesting and important. Everyone dies, and most adults live well into advanced ages in which they experience some level of physical decline before death. This period of decline is relevant to us as individuals, obviously, but also to society, which ultimately bears much of the financial burden of care via Medicare and Medicaid expenditures. Thus, it is important to understand the disability process in late life. In particular, concepts like “terminal drop” and “terminal decline” are of interest because, if we could recognize who is likely to experience which type of pattern, we might be able to develop interventions to improve quality of death, and we might be able to better predict end-of-life expenditures. The recent paper by Wolf et al. is intriguing for these reasons. In brief, the authors use time-to-death (TTD) as a predictor of disability trajectories. The key goal is to determine the number and shape of disability trajectories that immediately precede death, ultimately estimating the prevalence of those who experience terminal drop, terminal decline, and other patterns. Although I think the methodology is interesting and certainly meticulous, there are two key problems with studying disability trajectories as a function of TTD that should make one cautious when employing such an approach. First, treating TTD as a predictor of disability patterns that precede it confuses the direction of causality. Second, the approach suggested by the authors cannot yield any more useful information than a model that does not confuse the direction of causality can.
影响因子：
1.8
作者：
VAUPEL, JW;YASHIN, AI
通讯作者：
YASHIN, AI