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Updated: Jul 31, 2025

Improving Strength, Power, Muscle Aerobic Capacity, and Glucose Tolerance through Short-term Progressive Strength Training Among Elderly People
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Terminal Decline in Physical Function in Older Adults.

Erwin Stolz1, Hannes Mayerl1, Graciela Muniz-Terrera2,3

  • 1Institute of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria.

The Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
|May 6, 2023
PubMed
Summary

Physical function significantly accelerates in decline during the final years of life. This terminal decline, observed in older adults, begins years before death and is much steeper than earlier declines.

Keywords:
Change pointsEnd of lifeGait speedMortalityMotor decline

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Area of Science:

  • Gerontology
  • Biomedical Geriatrics
  • Public Health

Background:

  • The existence and timing of a terminal decline phase in physical function among older adults remain unclear.
  • Understanding this late-life decline is crucial for predicting health trajectories and informing care.

Purpose of the Study:

  • To investigate the onset and characteristics of terminal decline in physical function in older adults.
  • To compare the timing of physical function decline with causes of death.

Main Methods:

  • Utilized data from 702 deceased older adults (aged 70+) from the Yale PEP Study.
  • Assessed physical function using the Short Physical Performance Battery (SPPB) and continuous gait and chair rise tests up to 20 years pre-death.
  • Employed generalized mixed regression models with random change points to analyze decline onset and steepness.

Main Results:

  • Physical function (SPPB, gait, chair rise) showed accelerated decline in the final years of life.
  • Terminal decline onset varied: 1 year pre-death for SPPB, 2.5-2.6 years for chair rise and gait speed.
  • Terminal decline was 6-8 times steeper than pre-terminal decline; onset timing differed based on cause of death (frailty, dementia, cancer).

Conclusions:

  • Terminal decline in physical function is a distinct late-life phenomenon, similar to cognitive decline.
  • Findings provide evidence for rapid, impending death-related physical function decline in older adults.