Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline
Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline
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DOI：
10.1159/000490614
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发表时间：
2019-01-01
期刊：
影响因子：
3.5
通讯作者：
Theill, Nathan
中科院分区：
文献类型：
--
作者：
Hulur, Gizem;Wolf, Henrike;Theill, Nathan
背景：关于终末衰退的研究已经广泛证明，认知能力随着死亡的临近而急剧下降。到目前为止，还不清楚这些变化是否是规范的，基于与（临床前）痴呆相关的病理，或两者兼而有之。目的：我们分析了瑞士养老院居民终端认知变化轨迹的异质性，目的是检查终端变化是否是规范的，或者是否存在一个或多个相对稳定的亚组。研究方法：我们根据1998年至2014年期间341家养老院的居民评估工具-最小数据集的常规评估进行了纵向分析。总之，我们使用了30，054名居民（69%为女性，平均死亡年龄87岁）在生命的最后3年的143，052次观察。我们用潜在类增长曲线模型分析了认知表现量表（CPS）评分的轨迹，并检查了社会人口因素（死亡年龄，性别，婚姻状况，以前的生活状况）以及功能和心理健康（日常生活活动指数和抑郁评定量表）和痴呆症诊断作为组成员关系的相关因素。结果：我们根据CPS评分的纵向轨迹确定了三个不同的类别。在第一组（从无到轻度损害的过渡，27%）中，认知损害随着死亡时间的推移而增加（线性和二次），但始终保持在相对轻度的水平。第二组的轨迹（从中度到重度损害的转变，43%）的特征是在死亡时间内的线性和二次变化。第三组（重度损伤，30%）的轨迹特征为所有组中线性增加量最低，无二次增加，表明无加速变化。更好的功能健康和没有痴呆症的诊断预测较少的损害。较少的抑郁症状与低，而不是中度或重度，但也严重与中度损害。结论：我们的研究结果表明，大多数居民的经验终端的变化，除了那些已经在高水平的损害。此外，晚年认知变化与功能和心理健康有关。
Background: Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. Objectives: We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents with the objective of examining whether terminal change is normative or whether one or multiple subgroup(s) with relative stability exist. Methods: We performed a longitudinal analysis based on routine assessments with the Resident Assessment Instrument - Minimal Data Set in 341 nursing homes between 1998 and 2014. In sum, we used 143,052 observations from 30,054 residents (69% women, average age at death 87 years) in the last 3 years of life. We analyzed trajectories of the Cognitive Performance Scale (CPS) score with latent class growth curve models and examined sociodemographic factors (age at death, sex, marital status, prior living situation) as well as functional and mental health (Activities of Daily Living Index and Depression Rating Scale) and dementia diagnosis as correlates of group membership. Results: We identified three distinct classes based on longitudinal trajectories of the CPS score. In the first group (transition from no to mild impairment, 27%), cognitive impairment increased with time to death (linear and quadratic), but remained at relatively mild levels at all times. The trajectories of the second group (transition from moderate to severe impairment, 43%) were characterized by linear and quadratic changes across time to death. The trajectories of the third group (severe impairment, 30%) were characterized by the lowest amount of linear increase across all groups and no quadratic increase indicating no accelerated change. Better functional health and absence of a dementia diagnosis predicted less impairment. Fewer depressive symptoms were associated with low as opposed to moderate or severe, but also severe versus moderate impairment. Conclusion: Our findings suggest that the majority of residents experience terminal change, with the exception of those at already high levels of impairment. Furthermore, late-life cognitive change is related to functional and mental health.