|Acceleration of health deficit accumulation in late-life: Evidence of terminal decline in frailty index three years before death in the US Health and Retirement Study
|Year of Publication
|Stolz, E, Mayerl, H, Hoogendijk, EO, Armstrong, JJ, Roller-Wirnsberger, R, Freidl, W
|Annals of Epidemiology
|Aged, aged 80 and over, Death, Frailty, Geriatrics, repeated rounds of survey
BackgroundLittle 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 methods23,393 observations from up to the last 21 years of life of 5,713 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.ResultsThe average normal (pre-terminal) 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.ConclusionWe 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.