Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria.
Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
J Gerontol A Biol Sci Med Sci. 2024 Jan 1;79(1). doi: 10.1093/gerona/glad119.
It is currently unclear whether (and when) physical function exhibits a terminal decline phase, that is, a substantial acceleration of decline in the very last years before death.
702 deceased adults aged 70 years and older from the Yale PEP Study provided 4 133 measurements of physical function (Short Physical Performance Battery, SPPB) up to 20 years before death. In addition, continuous gait and chair rise subtest scores (in seconds) were assessed. Generalized mixed regression models with random change points were used to estimate the onset and the steepness of terminal decline in physical function.
Decline accelerated in the last years of life in all 3 measures of physical function. The onset of terminal decline occurred 1 year before death for the SPPB, and at 2.5 and 2.6 years before death for chair rise and gait speed test scores, respectively. Terminal declines in physical function were 6-8 times steeper than pre-terminal declines. Relative to those whose condition leading to death was frailty, participants who died from dementia and cancer had an up to 6 months earlier and 3 months later onset of terminal decline in SPPB, respectively.
Terminal decline in physical function among older adults is comparable to the more established terminal decline phenomenon in cognition. Our results provide additional evidence of late-life rapid decline in physical function due to impending death.
目前尚不清楚身体功能是否（以及何时）会出现终末下降阶段，即在死亡前的最后几年中，身体功能会出现实质性的加速下降。
耶鲁 PEP 研究中的 702 名年龄在 70 岁及以上的已故成年人提供了 4133 次身体功能（短体物理性能测试，SPPB）测量值，这些测量值是在死亡前 20 年内进行的。此外，还评估了连续的步态和椅子上升子测试分数（以秒为单位）。使用广义混合回归模型和随机变化点来估计身体功能终末下降的起始和陡峭程度。
所有 3 项身体功能测量值的下降在生命的最后几年都加速了。SPPB 的终末下降起始于死亡前 1 年，而椅子上升和步态速度测试分数的终末下降分别起始于死亡前 2.5 年和 2.6 年。身体功能的终末下降斜率是前终末下降斜率的 6-8 倍。与那些因脆弱而导致死亡的参与者相比，死于痴呆症和癌症的参与者 SPPB 的终末下降起始时间分别提前了 6 个月和 3 个月。
老年人身体功能的终末下降与认知功能中更成熟的终末下降现象相当。我们的研究结果为生命后期身体功能因即将死亡而迅速下降提供了额外的证据。
