The utility of estimating population-level trajectories of terminal wellbeing decline within a growth mixture modelling framework

Burns, Richard A.; Byles, Julie; Magliano, Dianna J.; Mitchell, Paul; Anstey, Kaarin J.

doi:10.1007/s00127-014-0948-3

Cited by 27 publications

(25 citation statements)

References 40 publications

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“…Future research should examine whether cognitive reserve serves as a protective factor even in a vulnerable population and life phase. Furthermore, previous research has shown that trajectories of terminal change for mental health and well-being are characterized by stability for most individuals [18]. It is an important question for future research whether nursing home residents can maintain mental health and well-being at the end of life despite cognitive decline.…”

Section: Discussionmentioning

confidence: 99%

“…In the present study, we used data from the last 3 years of life of 30,054 nursing home residents (69% women, age at death mean = 87.49 years, SD = 7.00 years, range = 65-103 years). In recent years, a growing number of studies have examined questions related to the heterogeneity of late-life development with latent class growth analyses [18][19][20][21]. In latent class growth analyses, the goal is to identify unobserved groups of individuals based on their longitudinal trajectories [22,23].…”

Section: Introductionmentioning

confidence: 99%

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Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

et al. 2018

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Background: Research on terminal decline has widely documented that cognitive performance steeply declines with nearing death. To date, it is unclear whether these changes are normative, based on pathologies associated with (preclinical) dementia, or both. Objectives: We analyzed heterogeneity in trajectories of terminal cognitive change in Swiss nursing home residents with the objective of examining whether terminal change is normative or whether one or multiple subgroup(s) with relative stability exist. Methods: We performed a longitudinal analysis based on routine assessments with the Resident Assessment Instrument – Minimal Data Set in 341 nursing homes between 1998 and 2014. In sum, we used 143,052 observations from 30,054 residents (69% women, average age at death 87 years) in the last 3 years of life. We analyzed trajectories of the Cognitive Performance Scale (CPS) score with latent class growth curve models and examined sociodemographic factors (age at death, sex, marital status, prior living situation) as well as functional and mental health (Activities of Daily Living Index and Depression Rating Scale) and dementia diagnosis as correlates of group membership. Results: We identified three distinct classes based on longitudinal trajectories of the CPS score. In the first group (transition from no to mild impairment, 27%), cognitive impairment increased with time to death (linear and quadratic), but remained at relatively mild levels at all times. The trajectories of the second group (transition from moderate to severe impairment, 43%) were characterized by linear and quadratic changes across time to death. The trajectories of the third group (severe impairment, 30%) were characterized by the lowest amount of linear increase across all groups and no quadratic increase indicating no accelerated change. Better functional health and absence of a dementia diagnosis predicted less impairment. Fewer depressive symptoms were associated with low as opposed to moderate or severe, but also severe versus moderate impairment. Conclusion: Our findings suggest that the majority of residents experience terminal change, with the exception of those at already high levels of impairment. Furthermore, late-life cognitive change is related to functional and mental health.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

et al. 2018

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“…To illustrate, the average decedent from the German SOEP study exhibited almost a full standard deviation (effect size units) decline in life satisfaction during the last four years of life. However, despite this overall negative picture of terminal decline in well-being, considerable individual differences exist (Burns, Byles, Magliano, Mitchell, & Anstey, 2014; Gerstorf & Ram, 2013). Although many people are exhibiting dramatic declines in well-being in the last years of their lives, there are some individuals who are able to maintain their well-being until (or very close to) the end of life.…”

Section: Well-being Trajectories In Adulthood and Late Lifementioning

confidence: 99%

Terminal decline in well-being: The role of social orientation.

Gerstorf¹,

Hoppmann²,

Löckenhoff³

et al. 2016

Psychology and Aging

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Well-being development at the end of life is often characterized by steep deteriorations, but individual differences in these terminal declines are substantial and not yet well understood. This study moved beyond the typical consideration of health predictors and explored the role of social orientation and engagement. To do so, we made use of social variables at the behavioral level (self-ratings of social participation) and the motivational level (valuing social and family goals), assessed two to four years before death. We applied single- and multi-phase growth models to up to 27-year annual longitudinal data from 2,910 now deceased participants of the nation-wide German Socio-Economic Panel Study (SOEP; age at death: M = 74 years; SD = 14; 48% women). Results revealed that leading a socially active life and prioritizing social goals in late life were independently associated with higher late-life well-being, less pronounced late-life decline, and a later onset of terminal decline. Significant interaction effects suggested that the effects of (reduced) social participation and (lowered) social goals were compounding each other.compound. Findings also indicated that less decline in social participation was associated with shallower rates and a later onset of well-being decline. We found little evidence that valuing family goals is associated with late-life trajectories of well-being. Associations were independent of key correlates of well-being and mortality, including age at death, gender, education, disability, hospital stays, and goals in other life domains. We discuss possible pathways by which maintaining social orientation into late life may help mitigate terminal decline in well-being.

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“…In contrast, increasing evidence suggests that longevity does not necessarily correspond to inevitable disability and dependency among the oldest old, possibly owing to higher mortality among those with disability and illness in earlier older adulthood . Alternative perspectives emphasize capacity for psychological growth and maintenance of positive functioning and independence regardless of disease state, even in the years preceding death . It may be that as survivors relative to their birth cohort, older adults who reach very late life may report positive health and functional capacity despite increasing incidence of medical conditions .…”

mentioning

confidence: 99%

“…10 Alternative perspectives emphasize capacity for psychological growth 11 and maintenance of positive functioning and independence regardless of disease state, [7][8][9]12,13 even in the years preceding death. 14,15 It may be that as survivors relative to their birth cohort, older adults who reach very late life may report positive health and functional capacity despite increasing incidence of medical conditions. 7 The oldest old are therefore increasingly viewed as a unique population for whom more needs to be known regarding their capabilities and health status.…”

mentioning

confidence: 99%

Heterogeneity in the Health and Functional Capacity of Adults Aged 85+ as Risk for Mortality

Burns

French

Luszcz

et al. 2019

J American Geriatrics Society

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OBJECTIVES To examine whether older adults aged 85+, with different health and functional capacities, cluster in different ways and to demonstrate whether individuals within particular clusters report differential mortality risk. DESIGN Retrospective cohort study. SETTING The Dynamic Analyses to Optimize Aging (DYNOPTA) project is a harmonization project of nine Australian longitudinal surveys of health and well‐being in adults aged 50+ between 1991 and 2006. PARTICIPANTS Participants were 685 older adults (female = 52%) living in the community and aged 85 to 103 at baseline who were followed until death or December 31, 2006, for survivors. MEASUREMENT Latent class analysis (LCA) analyzed self‐reported information on physical health, mental health, and functional capacity to define homogeneous classes based on probable cognitive impairment and depression status, medical conditions, and number of activities of daily living and instrumental activities of daily living. RESULTS LCA discriminated four classes reflecting two main survival patterns. Two classes reported half the median survival days; differences between these classes were related to high vs moderate depression and extent of functional limitations. Two classes reported better survival; differences between these classes were related to functional limitations, but both had low proportions with depression and dementia. The classes with shorter survival were associated with substantively higher rates of depression and dementia. CONCLUSION Higher rates of baseline depression and dementia were unique characteristics of those individuals in the clusters that reported shorter survival. However, a substantial proportion of very old adults experience good mental health with better survival outcomes. J Am Geriatr Soc 67:1036–1042, 2019.

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The utility of estimating population-level trajectories of terminal wellbeing decline within a growth mixture modelling framework

Cited by 27 publications

References 40 publications

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

Cognitive Change at the End of Life in Nursing Home Residents: Differential Trajectories of Terminal Decline

Terminal decline in well-being: The role of social orientation.

Heterogeneity in the Health and Functional Capacity of Adults Aged 85+ as Risk for Mortality

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