Erwin Stolz1, Hannes Mayerl2, Emiel O Hoogendijk3, Joshua J Armstrong4, Regina Roller-Wirnsberger5, Wolfgang Freidl2. 1. Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria. Electronic address: erwin.stolz@medunigraz.at. 2. Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria. 3. Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC - Location VU University Medical Center, Amsterdam, The Netherlands. 4. Department of Health Sciences, Lakehead University, Thunder Bay, Canada. 5. Department of Internal Medicine, Medical University of Graz, Graz, Austria.
Abstract
BACKGROUND: Little is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life. MATERIAL AND METHODS: A total of 23,393 observations from up to the last 21 years of life of 5713 deceased participants of the AHEAD cohort in the Health and Retirement Study were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual, self- and proxy-reported assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points. RESULTS: The average normal (preterminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI-value of 0.29 in the total sample, 0.27 for men, and 0.30 for women. CONCLUSION: We found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30.
BACKGROUND: Little is known about within-person frailty index (FI) changes during the last years of life. In this study, we assess whether there is a phase of accelerated health deficit accumulation (terminal health decline) in late-life. MATERIAL AND METHODS: A total of 23,393 observations from up to the last 21 years of life of 5713 deceased participants of the AHEAD cohort in the Health and Retirement Study were assessed. A FI with 32 health deficits was calculated for up to 10 successive biannual, self- and proxy-reported assessments (1995-2014), and FI changes according to time-to-death were analyzed with a piecewise linear mixed model with random change points. RESULTS: The average normal (preterminal) health deficit accumulation rate was 0.01 per year, which increased to 0.05 per year at approximately 3 years before death. Terminal decline began earlier in women and was steeper among men. The accelerated (terminal) rate of health deficit accumulation began at a FI-value of 0.29 in the total sample, 0.27 for men, and 0.30 for women. CONCLUSION: We found evidence for an observable terminal health decline in the FI following declining physiological reserves and failing repair mechanisms. Our results suggest a conceptually meaningful cut-off value for the continuous FI around 0.30.
Authors: Carole Fogg; Simon D S Fraser; Paul Roderick; Simon de Lusignan; Andrew Clegg; Sally Brailsford; Abigail Barkham; Harnish P Patel; Vivienne Windle; Scott Harris; Shihua Zhu; Tracey England; Dave Evenden; Francesca Lambert; Bronagh Walsh Journal: BMC Geriatr Date: 2022-01-06 Impact factor: 3.921