Psychological Terminal Decline as a Multidimensional Process of Age, Approaching

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DESCRIPTION (provided by applicant): Evidence is building that late-life changes in sensory and cognitive function are marked by pronounced, proximate to death terminal decline. Relatively little is known, however, about if and when other aspects of psychological functioning may deteriorate with approaching death or how such declines may be interrelated. The proposed project moves beyond current, single domain, examinations of terminal decline to consider and develop a multidimensional view of the processes underlying late-life change - "terminal cascades." We will examine late-life change across five domains broadly representative of the functional system in old age (sensory, physical, cognitive, well-being and social relations) and explore how these changes are interrelated. Objectives include (1) testing for unique associations between changes in functionality and subsequent mortality, (2) determining whether age-, death-, or pathology-related processes are the primary contributors to late-life change, and (3) describing the prototypical, multivariate change trajectories individuals follow into death. Recent and forthcoming innovations in the analysis of change will be applied to multidisciplinary 15-year longitudinal data from deceased participants of the Berlin Aging Study (N = 430+; 70-103 years). New analytic tools will be developed for modeling multivariate change. These tools and analyses shall allow for more precise descriptions of how individuals progress from one multivariate within-person profile of functioning to another over time (age, distance-to-death, pathology) and will thereby help to clarify which segments of society are likely to experience which types of decline. Empirical results will shed light on how and why some individuals age more successfully than others (e.g., experience less decline prior to death), point to particular pathways by which more and more individuals can maintain a life lived fully and with dignity into advanced ages, and yield practical information for the design and implementation of preventive interventions focused on alleviating the societal and personal costs of late-life decline. PUBLIC HEALTH RELEVANCE: The end of life in old age is often characterized by costly deteriorations in functionality and health - seemingly inevitable declines that contribute substantially to health care costs and societal burden. Little is known, however, about which aspects of late-life psychological function deteriorate, in what order, or how quickly such declines occur. As a first step in identifying the pathways by which more individuals can maintain a life lived fully and with dignity, the major goal of the proposed project is to obtain a better understanding of how late-life changes across domains of sensory, physical, cognitive, well-being, and social functionality are structured and interrelated. This knowledge will contribute to developing effective programs and policies that target the areas most likely to alleviate the social and personal costs of late-life decline (e.g., designing suitable health or hospice care).