Fluctuating Physical Function and Health: Their Role at the End of Life.

Background: Our recent research suggests that a fluctuating trajectory, previously thought to be the experience of those dying with heart failure or chronic lung disease, may not accurately characterize the end of life for these patients.

Objective: We sought to further examine health and function to investigate whether other measures or a different time frame captures the purported exacerbation/recovery trajectory associated with these diseases.

Design: Function and health data were collected prospectively at six-month intervals for 17 years during the Heath, Aging and Body Composition Study.

Mobility Trajectories at the End of Life: Comparing Clinical Condition and Latent Class Approaches.

Objectives: To assess mobility disability trajectories before death in a large sample of very old adults using two analytical approaches to determine how well they corresponded.

Design: Decedent sample from the Health, Aging and Body Composition (Health ABC) Study. Data were collected between 1997 and 2015.

Three Year Functional Trajectories Among Old Age Survivors and Decedents: Dying Eliminates a Racial Disparity.

Background: Long-term trajectories of disability comparing decedents and survivors and differences by race have not been assessed.

Objective: To examine self-reported difficulty in walking a quarter mile and the need for assistance with activities of daily living (ADL) beginning 3 years before death among decedents and age- and gender-matched survivors.

Design: A case-control sample drawn from the Health, Aging and Body Composition Study (Health ABC).

Are Preferences for Aggressive Medical Treatment Associated with Healthcare Utilization in the Very Old?

To examine the relationship between end-of-life (EOL) treatment preferences and recent hospitalization or emergency department (ED) care in the very old. Quarterly telephone follow-up of participants in the EOL in the Very Old cohort. The EOL in the Very Old Age cohort drew from 1403 participants in the Health, Aging, and Body Composition (Health ABC) study who were alive in year 15 of follow-up.

Factors Associated with Family Reports of Pain, Dyspnea, and Depression in the Last Year of Life.

Background: Pain, dyspnea, and depression are highly troubling near the end of life.

Objective: To characterize factors associated with clinically significant pain and the presence of dyspnea and depression during the last year of life in a nationally representative sample.

Design: Retrospective cohort study.

Symptom Burden and End-of-Life Treatment Preferences in the Very Old.

Context: End-of-life (EOL) treatment preferences among the very old (age 85+) may differ from preferences in younger aged populations because of high levels of symptom burden and disability and high risk of mortality. It is unclear if symptom burden or level of disability is more important for such preferences.

Objectives: To investigate whether distress from daily symptom burden was an independent correlate of EOL treatment preferences over two years of follow-up in people with median age 86 (participants) and 88 (reported by proxies) at baseline.

Symptom trends in the last year of life from 1998 to 2010: a cohort study.

Background: Calls for improvement in end-of-life care have focused attention on the management of pain and other troubling symptoms at the end of life.

Objective: To describe changes in pain intensity and symptom prevalence during the last year of life from 1998 to 2010.

Design: Observational study.

Prognostic significance of the "surprise" question in cancer patients.

Background: Physicians consistently overestimate survival for patients with cancer. The "surprise" question--"Would I be surprised if this patient died in the next year?"--improves end-of-life care by identifying patients with a poor prognosis. It has not been previously studied in patients with cancer.

Patterns of functional decline at the end of life.

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.

Profiles of older medicare decedents.

Objectives: To evaluate the usefulness of a clinical scheme to classify older decedents to better understand the issues associated with healthcare use and costs in the last year of life.

Design: We analyzed Medicare claims data for a random sample of 0.1% of all Medicare beneficiaries with expenditures between 1993 and 1998.