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

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Morgan, Deidre D.Flinders University (author)

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

Article/chapterEnglish2019

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2019-03-27
SAGE Publications,2019

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LIBRIS-ID:oai:lup.lub.lu.se:f34c251e-62c8-427f-8179-04f2a478ba2f
https://lup.lub.lu.se/record/f34c251e-62c8-427f-8179-04f2a478ba2fURI
https://doi.org/10.1177/0269216319839024DOI

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Language:English
Summary in:English

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SwePubSwePub

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Subject category:art swepub-publicationtype
Subject category:ref swepub-contenttype

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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.

Subject headings and genre

MEDICIN OCH HÄLSOVETENSKAP Hälsovetenskap Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi hsv//swe
MEDICAL AND HEALTH SCIENCES Health Sciences Health Care Service and Management, Health Policy and Services and Health Economy hsv//eng
end-of-life care
functional decline
functionally impaired elderly
Palliative care
trajectories

Added entries (persons, corporate bodies, meetings, titles ...)

Tieman, Jennifer J.Flinders University (author)
Allingham, Samuel F.University of Wollongong (author)
Ekström, Magnus P.Lund University,Lunds universitet,Lungmedicin, allergologi och palliativ medicin,Sektion II,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Andfåddhet och kronisk andningssvikt,Forskargrupper vid Lunds universitet,Respiratory Medicine, Allergology, and Palliative Medicine,Section II,Department of Clinical Sciences, Lund,Faculty of Medicine,Breathlessness and chronic respiratory failure,Lund University Research Groups,University of Technology Sydney(Swepub:lu)med-mue (author)
Connolly, AlannaUniversity of Wollongong (author)
Currow, David C.University of Technology Sydney,University of Wollongong,Flinders University (author)
Flinders UniversityUniversity of Wollongong (creator_code:org_t)

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In:Palliative Medicine: SAGE Publications33:6, s. 693-7030269-21631477-030X

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