Psychological Terminal Decline as a Multidimensional Process of Age, Approaching

描述（由申请人提供）：越来越多的证据表明，感觉和认知功能的晚年变化以明显的、接近死亡的末期衰退为标志。然而，对于心理功能的其他方面是否以及何时会随着死亡的临近而恶化，以及这种衰退如何相互关联，人们所知相对较少。拟议的项目超越了当前的单一领域，对终末衰退的检查，考虑并发展了一种多维的观点，即晚年变化背后的过程——“终末级联”。我们将研究老年功能系统（感官、身体、认知、幸福和社会关系）的五个领域的晚年变化，并探讨这些变化是如何相互关联的。目标包括：(1)测试功能变化与随后死亡率之间的独特关联，(2)确定年龄、死亡或病理相关过程是否是晚年变化的主要因素，以及(3)描述个体进入死亡的原型、多变量变化轨迹。最近和即将出现的变化分析方面的创新将应用于柏林老龄化研究（N = 430+； 70-103岁）的已故参与者的15年多学科纵向数据。将开发新的分析工具来模拟多元变化。这些工具和分析将允许更精确地描述个体如何随着时间（年龄、与死亡的距离、病理）从一种多元的个人功能特征发展到另一种，从而有助于澄清社会的哪些部分可能经历哪种类型的衰退。实证结果将阐明一些人如何以及为什么比其他人更成功地衰老（例如，在死亡之前经历的衰退较少），指出越来越多的人能够在老年时保持充分和有尊严的生活的特定途径，并为设计和实施侧重于减轻老年衰退的社会和个人成本的预防性干预措施提供实用信息。公共卫生相关性：老年生命结束的特点往往是功能和健康状况的严重恶化——这似乎是不可避免的衰退，大大增加了卫生保健费用和社会负担。然而，对于老年心理功能的哪些方面会恶化，以何种顺序恶化，以及这种衰退发生的速度有多快，人们知之甚少。作为确定更多个体能够维持完整而有尊严的生活的途径的第一步，拟议项目的主要目标是更好地了解晚年在感官、身体、认知、福祉和社会功能等领域的变化是如何结构化和相互关联的。这些知识将有助于制定有效的计划和政策，以最有可能减轻晚年衰退的社会和个人成本的领域为目标（例如，设计合适的健康或临终关怀）。

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).