Derived disability trajectories provide useful information about different facets of the end-of-life experience, found a recent study.1

“From an ethical perspective, the value of the paper is to defend the idea that we can describe different clinical groups or trajectories at the end of life — even if the trajectories of physical function are not ‘pure,’” says June R. Lunney, PhD, RN, the study’s lead author.

Individuals won’t necessarily experience the suggested pattern of physical decline. However, the information still is useful for talking about different plans for personal care or different decision-making approaches depending upon the patient’s clinical course.

“This clinical framework allows us to talk about the end of life in more concrete terms, rather than a general abstract concept,” Lunney explains.

The researchers analyzed a large sample of elderly adults to assess mobility disability trajectories before death. The lack of fit between them suggests a need for greater attention to heterogeneity in disability in the period before death, concluded the researchers. “Additionally, this research helps to make the point that dying suddenly with no care requirements or clinical decision-making is not a very likely option,” says Lunney.

Another study found that older adults who died were more disabled three years before death, and also had a greater risk of increasing disability over each subsequent six-month assessment.2

“It was no surprise to find that those who would die within a few years are more likely to be limited in physical function than those who will survive,” says lead author Lunney.

A more noteworthy finding: that the well-documented gap in functional ability between African-Americans and whites was erased in the final one to 1.5 years before death. “One could speculate that being sick enough to die involves diminished physical function, regardless of access to healthcare or lifetime physical fitness, or whatever else contributes to the racial gap,” says Lunney.

REFERENCES

1. Lunney JR, Albert SM, Boudreau R, et al. Mobility trajectories at the end of life: Comparing clinical condition and latent class approaches. J Am Geriatr Soc 2018; 66(3):503-508.

2. Lunney JR, Albert SM, Boudreau R, et al. Three year functional trajectories among old age survivors and decedents: Dying eliminates a racial disparity. J Gen Intern Med 2018; 33(2):177-181.

SOURCE

• June R. Lunney, PhD, RN, Hospice and Palliative Nurses Association, Pittsburgh. Email: june@lunney.org.