Advanced

The trajectory of functional decline over the last 4 months of life in a palliative care population : A prospective, consecutive cohort study

Morgan, Deidre D.; Tieman, Jennifer J.; Allingham, Samuel F.; Ekström, Magnus P. LU ; Connolly, Alanna and Currow, David C. (2019) In Palliative Medicine
Abstract

Background: Understanding current patterns of functional decline will inform patient care and has health service and resource implications. Aim: This prospective consecutive cohort study aims to map the shape of functional decline trajectories at the end of life by diagnosis. Design: Changes in functional status were measured using the Australia-modified Karnofsky Performance Status Scale. Segmented regression was used to identify time points prior to death associated with significant changes in the slope of functional decline for each diagnostic cohort. Sensitivity analyses explored the impact of severe symptoms and late referrals, age and sex. Setting/participants: In all, 115 specialist palliative care services submit prospectively... (More)

Background: Understanding current patterns of functional decline will inform patient care and has health service and resource implications. Aim: This prospective consecutive cohort study aims to map the shape of functional decline trajectories at the end of life by diagnosis. Design: Changes in functional status were measured using the Australia-modified Karnofsky Performance Status Scale. Segmented regression was used to identify time points prior to death associated with significant changes in the slope of functional decline for each diagnostic cohort. Sensitivity analyses explored the impact of severe symptoms and late referrals, age and sex. Setting/participants: In all, 115 specialist palliative care services submit prospectively collected patient data to the national Palliative Care Outcomes Collaboration across Australia. Data on 55,954 patients who died in the care of these services between 1 January 2013 and 31 December 2015 were included. Results: Two simplified functional decline trajectories were identified in the last 4 months of life. Trajectory 1 has an almost uniform slow decline until the last 14 days of life when function declines more rapidly. Trajectory 2 has a flatter more stable trajectory with greater functional impairment at 120 days before death, followed by a more rapid decline in the last 2 weeks of life. The most rapid rate of decline occurs in the last 2 weeks of life for all cohorts. Conclusions: Two simplified trajectories of functional decline in the last 4 months of life were identified for five patient cohorts. Both trajectories present opportunities to plan for responsive healthcare that will support patients and families.

(Less)
Please use this url to cite or link to this publication:
author
organization
publishing date
type
Contribution to journal
publication status
epub
subject
keywords
end-of-life care, functional decline, functionally impaired elderly, Palliative care, trajectories
in
Palliative Medicine
publisher
SAGE Publications Inc.
external identifiers
  • scopus:85063565825
ISSN
0269-2163
DOI
10.1177/0269216319839024
language
English
LU publication?
yes
id
f34c251e-62c8-427f-8179-04f2a478ba2f
date added to LUP
2019-04-10 14:27:56
date last changed
2019-04-30 04:11:09
@article{f34c251e-62c8-427f-8179-04f2a478ba2f,
  abstract     = {<p>Background: Understanding current patterns of functional decline will inform patient care and has health service and resource implications. Aim: This prospective consecutive cohort study aims to map the shape of functional decline trajectories at the end of life by diagnosis. Design: Changes in functional status were measured using the Australia-modified Karnofsky Performance Status Scale. Segmented regression was used to identify time points prior to death associated with significant changes in the slope of functional decline for each diagnostic cohort. Sensitivity analyses explored the impact of severe symptoms and late referrals, age and sex. Setting/participants: In all, 115 specialist palliative care services submit prospectively collected patient data to the national Palliative Care Outcomes Collaboration across Australia. Data on 55,954 patients who died in the care of these services between 1 January 2013 and 31 December 2015 were included. Results: Two simplified functional decline trajectories were identified in the last 4 months of life. Trajectory 1 has an almost uniform slow decline until the last 14 days of life when function declines more rapidly. Trajectory 2 has a flatter more stable trajectory with greater functional impairment at 120 days before death, followed by a more rapid decline in the last 2 weeks of life. The most rapid rate of decline occurs in the last 2 weeks of life for all cohorts. Conclusions: Two simplified trajectories of functional decline in the last 4 months of life were identified for five patient cohorts. Both trajectories present opportunities to plan for responsive healthcare that will support patients and families.</p>},
  author       = {Morgan, Deidre D. and Tieman, Jennifer J. and Allingham, Samuel F. and Ekström, Magnus P. and Connolly, Alanna and Currow, David C.},
  issn         = {0269-2163},
  keyword      = {end-of-life care,functional decline,functionally impaired elderly,Palliative care,trajectories},
  language     = {eng},
  publisher    = {SAGE Publications Inc.},
  series       = {Palliative Medicine},
  title        = {The trajectory of functional decline over the last 4 months of life in a palliative care population : A prospective, consecutive cohort study},
  url          = {http://dx.doi.org/10.1177/0269216319839024},
  year         = {2019},
}