Trajectories of End of Life: A Systematic Review

Cohen‐Mansfield, Jiska; Skornick-Bouchbinder, Michal; Brill, Shai

doi:10.1093/geronb/gbx093

Cited by 98 publications

(80 citation statements)

References 42 publications

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“…Our results also relate to the question as to when the end-of-life phase begins [17]. According to a recent systematic review [30], this phase begins with the onset of terminal decline, which, according to our results based on a measure of a person's whole health (the FI), would be around 3 years before death. These results are compatible with findings from studies on the onset of terminal decline in cognition [31] and motor function [32].…”

Section: Discussionsupporting

confidence: 70%

Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement study

Stolz

Mayerl

Hoogendijk

et al. 2020

Preprint

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Background: Little is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life. Material and methods: 23,393 observations from up to the last 21 years of life of 5,713 deceased participants of the AHEAD cohort in the Survey of Health and Retirement were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points. Results: The average normal (pre-terminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI value of 0.29 in the total sample, 0.27 for men, and 0.30 for women. Conclusion: We found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30.

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Section: Discussionsupporting

confidence: 70%

Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement study

Stolz

Mayerl

Hoogendijk

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Over the past decades, advances in medical care have resulted in substantial increases in life expectancy [14]. At the same time, medical progress has also led to an increased medicalization of health, especially at the end of life [15], which may not always be beneficial to patients [16]. Whereas some people are willing to undergo all potential treatments to sustain or extend their life for as long as possible [17], others consider certain health states as worse than death [18], and may, therefore, contemplate euthanasia or AS [19].…”

Section: Introductionmentioning

confidence: 99%

Associations of end-of-life preferences and trust in institutions with public support for assisted suicide evidence from nationally representative survey data of older adults in Switzerland

et al. 2020

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The legality of euthanasia and assisted suicide (AS) and nature of regulations of these practices remain controversial and the subject of lively debate among experts and the general public. Our study investigates attitudes and behaviours towards AS among older adults in Switzerland where the practice of AS has a relatively long history and remains rather unregulated. We aim to explore how individuals' preferences regarding their end of life, as well as individuals' trust in institutions involved in the practice or control of AS are associated with attitudes and behaviours towards AS. We analyse nationally representative data of adults aged 55 and over from wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) in Switzerland (n = 2,145). While large majorities supported current legal arrangements around AS in Switzerland (81.7%) and stated that they could consider AS for themselves under certain circumstances (61.0%), only a minority either was a member of a right-to-die organisation already (4.9%) or stated they were likely to become a member of such an organisation (28.2%). Stated preferences for control over the end of life and for maintaining essential capabilities at the end of life showed a positive association with AS-related attitudes and behaviours, whereas preferences for feeling socially and spiritually connected, as well as for not being a burden displayed a negative association with our outcomes. Higher levels of trust in one's relative were positively associated with both support for the legality of AS and potential use of AS. A positive association was also found between trust in the Swiss legal system and support for the legality of AS. By contrast, trust in religious institutions displayed a negative association with all five AS-related attitudes and behaviours. Similarly, trust in healthcare insurance companies was negatively associated with potential use of AS. Taken together, older adults were generally supportive towards current practices regarding AS. This approval appears to be closely related to individuals' preferences and, at different extends, to trust in social and public institutions with regard to end-of-life issues, which is relatively high in Switzerland.

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“…It is less clear why residents with better mobility before death would have shorter lengths of stays. One diagnosis, cancer, was associated with shorter lengths of stay in the between country analysis, possibly reflecting the relatively fast period of decline experienced in this condition 40…”

Section: Discussionmentioning

confidence: 98%

Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study

et al. 2020

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ObjectivesThis paper aims to investigate resident, facility and country characteristics associated with length of stay in long-term care facilities (LTCFs) across six European countries.SettingData from a cross-sectional study of deceased residents, conducted in LTCFs in Belgium, England, Finland, Italy, the Netherlands and Poland.ParticipantsAll residents aged 65 years and older at admission who died in a 3-month period residing in a proportional random sample of LTCFs were included.Primary and secondary outcome measuresThe primary outcome was length of stay in days, calculated from date of admission and date of death. Resident, facility and country characteristics were included in a proportional hazards model.ResultsThe proportion of deaths within 1 year of admission was 42% (range 32%–63%). Older age at admission (HR 1.04, 95% CI 1.03 to 1.06), being married/in a civil partnership at time of death (HR 1.47, 95% CI 1.13 to 1.89), having cancer at time of death (HR 1.60, 95% CI 1.22 to 2.10) and admission from a hospital (HR 1.84, 95% CI 1.43 to 2.37) or another LTCF (HR 1.81, 95% CI 1.37 to 2.40) were associated with shorter lengths of stay across all countries. Being female (HR 0.72, 95% CI 0.57 to 0.90) was associated with longer lengths of stay.ConclusionsLength of stay varied significantly between countries. Factors prior to LTCF admission, in particular the availability of resources that allow an older adult to remain living in the community, appear to influence length of stay. Further research is needed to explore the availability of long-term care in the community prior to admission and its influence on the trajectories of LTCF residents in Europe.

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Trajectories of End of Life: A Systematic Review

Abstract: Further research is needed to combine methods of investigation in order to assist the health care system in personalizing services to the trajectories of decline, and in enabling caregivers to prepare for the EOL experience.

Cited by 98 publications

References 42 publications

Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement study

Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement study

Associations of end-of-life preferences and trust in institutions with public support for assisted suicide evidence from nationally representative survey data of older adults in Switzerland

Length of stay in long-term care facilities: a comparison of residents in six European countries. Results of the PACE cross-sectional study

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