According to NIH investigators led by Dr. June Lunney, distinctly different patterns in patients' loss of functionality during the final year of life indicates a need for different approaches to palliative care.
One size does not fit all
In discussing the study, Dr. Lunney stated, "A 'one size fits all' model for end-of-life palliative care doesn't work. People usually assume a terminal illness when thinking about the end of life. Yet only 23-percent of Americans die of cancer, the most common illness with a distinct terminal phase. Most, particularly those who are chronically ill, are not diagnosed as 'terminal,'" she added, "yet they may also need palliative care." Palliative care offered mainly by hospice emphasizes compassionate therapies focused on physical, psychological, social and spiritual needs of the patient, family and caregiver. Currently, those services may not be available, because reimbursement for hospice requires a diagnosis that predicts a life expectancy of six months or less if the terminal illness runs its normal course.
The four pathways to death used in the study and their patterns of decline during a one-year period were:
According to Dr. Patricia A. Grady, Director of the NINR, "Clearly end-of-life palliative care needs to have a more extensive focus. This study shows that because of the different ways people die, palliative care should start earlier for those who need it, and should involve health and social services that are adjusted to fit the anticipated patterns of illness and death."
Palliative care refers to methods of treatment intended to sooth the symptoms of a disease or disorder without effecting a cure. In treating the terminally ill, the ultimate goal of palliative care is to improve the quality of the patient's remaining life.
The NIH research team analyzed data from 4,190 participants 65 years of age and older who were asked about common activities of daily living, such as bathing, dressing, using the toilet, or walking across a small room. The study found that while dependency increased at older ages, the level of dependence followed similar declines within each age group. Females were more disabled than males, but their slope of decline a year prior to death was the same. There were no differences in functional decline according to level of education or race.
The study was funded by the National Institute of Nursing Research and conducted in the Laboratory of Epidemiology, Demography and Biometry of the National Institute on Aging. Both institutes are part of the NIH, Department of Health and Human Services.
The article on the study, "Patterns of Functional Decline at the End of Life," appears in the May 14 issue of JAMA.
More information about nursing research is available at the NINR website at http://www.nih.gov/ninr.
