The trajectory of functional decline over the last 4 months of life in a palliative care population: A prospective, consecutive cohort study

Abstract

Background: Understanding current patterns of functional decline will inform patient care and has health service and resource implications. Aim: This prospective consecutive cohort study aims to map the shape of functional decline trajectories at the end of life by diagnosis. Design: Changes in functional status were measured using the Australia-modified Karnofsky Performance Status Scale. Segmented regression was used to identify time points prior to death associated with significant changes in the slope of functional decline for each diagnostic cohort. Sensitivity analyses explored the impact of severe symptoms and late referrals, age and sex. Setting/participants: In all, 115 specialist palliative care services submit prospectively collected patient data to the national Palliative Care Outcomes Collaboration across Australia. Data on 55,954 patients who died in the care of these services between 1 January 2013 and 31 December 2015 were included. Results: Two simplified functional decline trajectories were identified in the last 4 months of life. Trajectory 1 has an almost uniform slow decline until the last 14 days of life when function declines more rapidly. Trajectory 2 has a flatter more stable trajectory with greater functional impairment at 120 days before death, followed by a more rapid decline in the last 2 weeks of life. The most rapid rate of decline occurs in the last 2 weeks of life for all cohorts. Conclusions: Two simplified trajectories of functional decline in the last 4 months of life were identified for five patient cohorts. Both trajectories present opportunities to plan for responsive healthcare that will support patients and families.

Breathlessness, Anxiety, Depression, and Function–The BAD-F Study: A Cross-Sectional and Population Prevalence Study in Adults

“…[30] Rate of change in functional status is strongly correlated with and predictive of prognosis in cancer and AIDS. [31,32] The relationship at a population level of the strong relationship between functional change and depression and anxiety is striking and has not been reported before. Functional decline leads to decreasing autonomy, loss of independence, increasing social isolation, [33] deconditioning which can further worsen breathlessness all of which may contribute to aggravating anxious and depressive symptoms.…”

Conserving dignity and facilitating adaptation to dependency with intimate hygiene for people with advanced disease: A qualitative study

“…1 The impact of unwelcome dependency with deeply personal care needs is further heightened when experienced in conjunction with cumulative losses as death approaches. 2,3 Ability to engage in everyday activities becomes increasingly effortful towards the end of life, with the majority of people requiring assistance with self-care, 4 including intimate hygiene. While difficult to reconcile, 5 people strive to maintain independence for as long as possible as dependency increases.…”

The efficacy of specialised rehabilitation using the Op-reha Guide for cancer patients in palliative care units: protocol of a multicentre, randomised controlled trial (JORTC-RHB02)

“…Cancer patients in the terminal phase experience a decline in physical function and activities of daily living (ADL). ADL decline occurs in many cancer patients between 1 and 3 months before death [1,2]. Many cancer patients wish to maintain their independence even in the terminal phase; thus, the deterioration of physical function and ADL in terminal cancer patients may cause a decrease in their quality of life (QOL) [3,4].…”