Disability trajectories in relation to impending death

Abstract Background We examined the development of limitations in activities of daily living (ADL) over a decade in relation to impending death among decedents aged 70 or older and investigated associations with sex, age at death, birth cohort, education, cognitive decline, and chronic conditions. Methods We pooled data from six longitudinal aging studies in Sweden, collected between 1997 and 2016 and harmonized by the National E-infrastructure for Aging Research (NEAR). Respondents, all descendants who had died at age 70 or older, reported ADL limitations on a scale from 0 to 5. We analyzed data from four time intervals before death (0-2, >2-4, >4-6, and 6-12 years) for those with ADL data from at least two time points (n = 2294, 62% women, mean age at death 89.8 (SD 6.5) years). We applied group-based trajectory modeling to identify disability trajectories, multinomial logistic regression to examine demographic associations, and generalized estimating equations to determine the associations of cognitive decline and chronic conditions with the trajectories. Results We identified three disability trajectories: Constantly low (53%), Low-sharply increasing (36%), and High-increasing (11%). Women were more likely than men to follow trajectories where ADL limitations increased sharply or remained high. Older age at death, earlier birth cohort, and low education were also associated with these less favorable trajectories. High-increasing trajectory was linked to a high risk of cognitive decline, whereas Constantly low trajectory was associated with an increased risk of cancer and cardiovascular disease. Conclusions For most individuals, ADL limitations remained low until the final two years of life. However, distinct disability trajectories with steady or sharp increases over the final decade of life also emerged. Cognitive decline is associated with a longer duration and higher level of disability. Key messages • Most older adults maintain functional ability until their final two years, but a significant number need support in daily activities during their last decade, especially those with cognitive decline. • Identifying demographic and health-related risk factors for severe functional decline can help target interventions to support late-life functional ability and predict future care needs.