Terminal change in functional decline of nursing home residents with and without advanced dementia

Background: Decline in physical functioning has been reported to indicate impending death of residents in long-term care. However, the role of dementia remains unclear, as well as time of onset of terminal decline and the amount of change compared to preterminal decline. Objective(s): To investigate terminal change in functional decline of nursing home residents with advanced, mild or no dementia. Method(s): Mulitphase growth models were applied to retrospective data of the last 24 months of 44,811 deceased residents (mean age at death: 87.46+/-7.17, 67.6% women) of 358 Swiss nursing homes between 1998 and 2014. Physical functioning was assessed with the activities of daily living (ADL) index of the Resident Assessment Instrument-Minimum Data Set (RAI-MDS). Result(s): Results revealed an acceleration of functional decline between two and three months before death in all three groups. For individuals without dementia, terminal decline was 1.5 points per month compared to 0.1 points during pre-terminal decline. While residents with mild dementia only showed slight differences in end-of-life trajectories compared to the non demented residents, advanced dementia was related to a lower physical functioning as well as less severe rate of terminal decline. Conclusion(s): Impending death of nursing home residents is indicated by terminal change in functional decline between two to three months before death. Although global level of physical functioning is lowered in residents with advanced dementia, they still show a considerable increase in end-of-life functional decline.

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