Résumé :
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[BDSP. Notice produite par INIST-CNRS fK0R0xH7. Diffusion soumise à autorisation]. Context Clinicians have observed various patterns of functional decline at the end of life, but few empirical data have tested these patterns in large populations. Objective To determine if functional decline differs among 4 types of illness trajectories : sudden death, cancer death, death from organ failure, and frailty. Design, Setting, and Participants Cohort analysis of data from 4 US regions in the prospective, longitudinal Established Populations for Epidemiologic Studies of the Elderly (EPESE) study. Of the 14456 participants aged 65 years or older who provided interviews at baseline (1981-1987), 4871 died during the first 6 years of follow-up ; 4190 (86%) of these provided interviews within 1 year before dying. These decedents were evenly distributed in 12 cohorts based on the number of months between the final interview and death. Main Outcome Measures Self-or proxy-reported physical function (performance of 7 activities of daily living [ADLs]) within 1 year prior to death ; predicted ADL dependency prior to death. Results Mean function declined across the 12 cohorts, simulating individual decline in the final year of life. Sudden death decedents were highly functional even in the last month before death (mean [95% confidence interval [CI] numbers of ADL dependencies : 0.69 [0.19-1.19] at 12 months before death vs 1.22 [0.59-1.85] at the final month of life, P=20) ; cancer decedents were highly functional early in their final year but markedly more disabled 3 months prior to death (0.77 [0.30-1.24] vs 4.09 [3.37-4.81], P<. organ failure decedents experienced a fluctuating pattern of decline with substantially poorer function during the last months before death vs p and frail were relatively more disabled in final year especially dependent month after controlling for age sex race education marital status interval between interview other demographic differences than times likely sudden to be adl cl cancer one half conclusions trajectories functional at end life are quite variable. differentiating among expected related needs would help shape tailored strategies better programs care prior death.>
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