生命最后一年的残疾轨迹。
Trajectories of disability in the last year of life.
机构信息
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
出版信息
N Engl J Med. 2010 Apr 1;362(13):1173-80. doi: 10.1056/NEJMoa0909087.
BACKGROUND
Despite the importance of functional status to older persons and their families, little is known about the course of disability at the end of life.
METHODS
We evaluated data on 383 decedents from a longitudinal study involving 754 community-dwelling older persons. None of the subjects had disability in essential activities of daily living at the beginning of the study, and the level of disability was ascertained during monthly interviews for more than 10 years. Information on the conditions leading to death was obtained from death certificates and comprehensive assessments that were completed at 18-month intervals after the baseline assessment.
RESULTS
In the last year of life, five distinct trajectories were identified, from no disability to the most severe disability: 65 subjects had no disability (17.0%), 76 had catastrophic disability (19.8%), 67 had accelerated disability (17.5%), 91 had progressive disability (23.8%), and 84 had persistently severe disability (21.9%). The most common condition leading to death was frailty (in 107 subjects [27.9%]), followed by organ failure (in 82 subjects [21.4%]), cancer (in 74 subjects [19.3%]), other causes (in 57 subjects [14.9%]), advanced dementia (in 53 subjects [13.8%]), and sudden death (in 10 subjects [2.6%]). When the distribution of the disability trajectories was evaluated according to the conditions leading to death, a predominant trajectory was observed only for subjects who died from advanced dementia (67.9% of these subjects had a trajectory of persistently severe disability) and sudden death (50.0% of these subjects had no disability). For the four other conditions leading to death, no more than 34% of the subjects had any of the disability trajectories. The distribution of disability trajectories was particularly heterogeneous among the subjects with organ failure (from 12.2 to 32.9% of the subjects followed a specific trajectory) and frailty (from 14.0 to 27.1% of the subjects followed a specific trajectory).
CONCLUSIONS
In most of the decedents, the course of disability in the last year of life did not follow a predictable pattern based on the condition leading to death.
背景
尽管功能状态对老年人及其家庭很重要，但人们对生命末期残疾的发展过程知之甚少。
方法
我们评估了一项涉及 754 名社区居住老年人的纵向研究中 383 名死者的数据。研究开始时，所有受试者均无日常生活活动的基本活动能力障碍，并且在超过 10 年的每月访谈中确定了残疾程度。导致死亡的情况的信息是从死亡证明和全面评估中获得的，这些评估是在基线评估后 18 个月进行的。
结果
在生命的最后一年，从无残疾到最严重残疾，确定了五种不同的轨迹：65 名受试者无残疾（17.0%），76 名受试者发生灾难性残疾（19.8%），67 名受试者残疾加速（17.5%），91 名受试者残疾进展（23.8%），84 名受试者持续严重残疾（21.9%）。导致死亡的最常见情况是虚弱（107 名受试者[27.9%]），其次是器官衰竭（82 名受试者[21.4%]），癌症（74 名受试者[19.3%]），其他原因（57 名受试者[14.9%]），晚期痴呆（53 名受试者[13.8%]）和猝死（10 名受试者[2.6%]）。当根据导致死亡的条件评估残疾轨迹的分布时，仅在死于晚期痴呆的受试者中观察到主要轨迹（67.9%的这些受试者的轨迹为持续严重残疾）和猝死（50.0%的这些受试者无残疾）。对于其他四种导致死亡的情况，只有不超过 34%的受试者具有任何残疾轨迹。在器官衰竭（从 12.2%到 32.9%的受试者遵循特定轨迹）和虚弱（从 14.0%到 27.1%的受试者遵循特定轨迹）的受试者中，残疾轨迹的分布特别不均匀。
结论
在大多数死者中，生命最后一年的残疾发展过程并没有遵循基于导致死亡的情况的可预测模式。
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