Deeg Dorly J H, Pasman H Roeline W, Huisman Martijn, Onwuteaka-Philipsen Bregje D
Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute/Ageing and Later Life Program, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands.
Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health Research Institute/Ageing and Later Life Program, P.O. Box 7057, 1007 MB, Amsterdam, the Netherlands.
SSM Popul Health. 2025 Aug 30;31:101858. doi: 10.1016/j.ssmph.2025.101858. eCollection 2025 Sep.
The mortality decline during the past decades has postponed the age at death. Dying at older ages may involve alterations in health trajectories at the end of life. This study examined 10-year period differences in level and changes in health conditions from 3 months to 3 days before death. Distinction was made between cancer and non-cancer decedents, because their trajectories are known to differ.
Data were provided by proxies of participants in the Dutch population-based Longitudinal Aging Study Amsterdam, who died between 2005-2009 (midyear 2008) and 2017-2019 (midyear 2018), with complete data for 162 and 124 decedents, respectively. Health conditions included functional limitations, symptom severity, and low consciousness.
Average age at death increased from 81.0 (2008) to 83.5 (2018). 48 % of decedents were men. Cancer constituted 33 % of causes of death. Controlling for sex, age at death, and education, non-cancer decedents experienced more often low consciousness at 3 months before death in 2018 than in 2008. At 3 months in 2018, cancer decedents experienced fewer functional limitations than in 2008 and fewer than non-cancer decedents. In both periods, cancer decedents experienced steeper functional declines than non-cancer decedents. Trajectories of symptom severity were similar in cancer and non-cancer decedents in both periods.
In non-cancer decedents, but not in cancer decedents, the dying process was more protracted in 2018 than in 2008. Level and increase in symptom severity did not improve over time for both cancer and non-cancer decedents, suggesting that improvement of palliative care is warranted for both groups.
过去几十年死亡率的下降推迟了死亡年龄。在较高年龄死亡可能涉及生命末期健康轨迹的改变。本研究考察了从死亡前3个月到3天这一时间段内，健康状况水平和变化情况的10年差异。对癌症和非癌症死者进行了区分，因为已知他们的轨迹有所不同。
数据由荷兰基于人群的阿姆斯特丹纵向衰老研究参与者的代理人提供，这些参与者分别于2005 - 2009年（2008年年中）和2017 - 2019年（2018年年中）死亡，分别有162例和124例死者的完整数据。健康状况包括功能受限、症状严重程度和意识水平低下。
平均死亡年龄从2008年的81.0岁增加到2018年的83.5岁。48%的死者为男性。癌症占死因的33%。在控制性别、死亡年龄和教育程度后，2018年非癌症死者在死亡前3个月出现意识水平低下的情况比2008年更频繁。在2018年3个月时，癌症死者的功能受限情况比2008年更少，且少于非癌症死者。在两个时期，癌症死者的功能下降都比非癌症死者更陡峭。两个时期癌症和非癌症死者的症状严重程度轨迹相似。
在非癌症死者中，但不是癌症死者中，2018年的死亡过程比2008年更漫长。癌症和非癌症死者的症状严重程度水平和增加情况均未随时间改善，这表明两组都有必要改善姑息治疗。
