The study from the Yale University School of Medicine identifies five main categories of disability but finds that it is difficult to predict older people’s experience of disability in the last year of their lives. Thomas M. Gill and colleagues argue there is a high level of disability in the last month of life, yet found than 50% of subjects were not disabled 12 months before death.

 

The study looked at 383 decedents from a longitudinal study involving 754 community-dwelling older people aged 70 and over. They were initially free of disability and the onset and extent of disability was assessed during monthly interviews over more than a ten year period. Conditions leading to death were attained through death certificates and assessments.

The researchers noted five trajectories in the last year of life: no disability (17 percent), catastrophic disability (19.8 percent), accelerated disability (17.5 percent), progressive disability (23.8 percent), and persistently severe disability (21.9 percent). They found that these trajectories varied widely among people and their conditions.

The most common condition leading to death was frailty (27.9%), organ failure (21.4%), cancer (19.3%), other causes (14.9%), advanced dementia (13.8%), and sudden death (2.6%).

 

Only those who died of advanced dementia or sudden death showed a predominant trajectory (67.9 percent of the first group had persistently severe disability; 50 percent of the second group had no disability).

"Our results suggest that the need for services at the end of life to assist with essential activities of daily living is at least as great for older persons dying from organ failure and frailty as for those dying from a more traditional terminal condition such as cancer, and that the need is much greater for older persons dying from advanced dementia," the authors conclude.

The study raises important points for researchers and policymakers. For policy makers the findings pose challenges in terms of planning effective, targeted healthcare services for our ageing population. The study does however underline the importance of service provision for older people living with dementia. For researchers the study also shows that more research is needed in assessing the course of disability and investigating functionality in later years to inform strategies especially for end of life care. It raises particular issues for older people, families and care givers in relation to planning flexible and appropriate end of life care.