Progressive Dwindling in Multiple Sclerosis: An Opportunity to Improve Care

Area of Science:

• Neurology
• Gerontology
• Palliative Care

Background:

• 40% of deaths in the elderly follow a
• progressive dwindling
• trajectory, marked by increasing disability and frailty.
• Current healthcare systems inadequately address the needs of individuals on this trajectory.
• Formative care, a coordinated medical and social approach, could benefit those with progressive dwindling.

Purpose of the Study:

• To quantify the proportion of people with multiple sclerosis (pwMS) who experience a progressive dwindling trajectory before death.
• To investigate the relationship between this trajectory and place of death.
• To identify predictors of the progressive dwindling trajectory in pwMS.

Main Methods:

• A retrospective observational study involving 582 deceased pwMS.
• Data sourced from the UK MS Tissue Bank, including death certificates and clinical summaries.

Main Results:

• A significant majority (73.7%) of pwMS exhibited a progressive dwindling trajectory.
• Earlier achievement of MS disease milestones predicted this trajectory.
• 72.5% of deaths were MS-related, with aggressive disease courses predicting this outcome.
• Individuals with progressive dwindling were as likely to die in hospital as those with other trajectories.

Conclusions:

• The progressive dwindling trajectory is highly prevalent in pwMS and predictable by early disease milestones.
• Targeted formative care interventions during the years preceding death could improve outcomes for pwMS.
• This research underscores the importance of recognizing and addressing progressive dwindling in multiple sclerosis care.