Patterns of functional decline at the end of life
Patterns of functional decline at the end of life
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DOI：
10.1001/jama.289.18.2387
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发表时间：
2003-05-14
影响因子：
120.7
通讯作者：
Guralnik, JM
中科院分区：
文献类型：
--
作者：
Lunney, JR;Lynn, J;Guralnik, JM
背景临床医生已经观察到各种模式的功能下降在生命的尽头，但很少有经验数据已经测试这些模式在大population.Objective确定功能下降是否不同4种类型的疾病轨迹：猝死、癌症死亡、器官衰竭死亡和虚弱。设计、设置和参与者队列分析来自美国4个地区的前瞻性数据，老年人流行病学研究（EPESE）的纵向人群。在基线（1981-1987年）提供访谈的14456名年龄在65岁或以上的参与者中，4871人在随访的前6年死亡;其中4190人（86%）在死亡前1年内提供了访谈。这些死者均匀分布在12个coholts的基础上的最后一次面试和death.Main Outcome Measures之间的月数自我或代理人报告的身体功能（性能的7个日常生活活动[ADL]）在1年内死亡前，预测ADL依赖性previoustowerdeath.Results平均功能下降在12个coholts，模拟个人在生命的最后一年下降。猝死者即使在死前一个月也有很高的功能（ADL依赖性的平均[95%置信区间{CI}]数量：死亡前12个月为0.69 [0.19-1.19]，生命最后一个月为1.22 [0.59-1.85]，P= 0.20）;癌症死亡者在最后一年的早期功能很强，但死亡前3个月的残疾程度明显更高（0.77 [0.30-1.24] vs 4.09 [3.37-4.81]，P
Context Clinicians have observed various patterns of functional decline at the end of life, but few empirical data have tested these patterns in large populations.Objective To determine if functional decline differs among 4 types of illness trajectories: sudden death, cancer death, death from organ failure, and frailty.Design, Setting, and Participants Cohort analysis of data from 4 US regions in the prospective, longitudinal Established Populations for Epidemiologic Studies of the Elderly (EPESE) study. Of the 14456 participants aged 65 years or older who provided interviews at baseline (1981-1987), 4871 died during the first 6 years of follow-up; 4190 (86%) of these provided interviews within 1 year before dying. These decedents were evenly distributed in 12 cohorts based on the number of months between the final interview and death.Main Outcome Measures Self-or proxy-reported physical function (performance of 7 activities of daily living [ADLs]) within 1 year prior to death; predicted ADL dependency prior to death.Results Mean function declined across the 12 cohorts, simulating individual decline in the final year of life. Sudden death decedents were highly functional even in the last month before death (mean [95% confidence interval {CI}] numbers of ADL dependencies: 0.69 [0.19-1.19] at 12 months before death vs 1.22 [0.59-1.85] at the final month of life, P=.20); cancer decedents were highly functional early in their final year but markedly more disabled 3-months prior to death (0.77 [0.30-1.24] vs 4.09 [3.37-4.81], P