Patterns of Functional Decline at the End of Life

In a large study designed to study patterns of functional decline in the last year of life, 4190 subjects were interviewed in the last year of their lives. Based on the results, Drs. Lunney and Lynn proposed 4 trajectories of functional decline at the end of life:

Sudden death Subjects in this category were substantially more independent and these cohorts did not decline in function as death approached.
Cancer trajectory Patients with cancer were noted to have a steady functional decline over time with a short terminal phase.
Organ failure (Congestive heart failure, Chronic obstructive pulmonary disease): Patients in this category experience a disease course characterized by slow decline with periodic crises and sudden death with a significant functional decline in the last few months of life.
Frailty / dementia: Patients in this category tend to have progressive and significant debility in the last year of life.
Source: Lunney, June R. PhD, RN; Lynn, Joanne MD, MA, MS; Foley, Daniel J. MS; Lipson, Steven MD; Guralnik, Jack M. MD, PhD “Patterns of Functional Decline at the End of Life” JAMA, Volume 289(18), 14 May 2003, p 2387–2392)
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