Two decades of end-of-life conditions of older adults: older and more protracted?

The mortality decline during the past decades has postponed the age at death. Dying at older ages may involve alterations in health trajectories at the end of life. This study examined 10-year period differences in level and changes in health conditions from 3 months to 3 days before death. Distinction was made between cancer and non-cancer decedents, because their trajectories are known to differ.

Data were provided by proxies of participants in the Dutch population-based Longitudinal Aging Study Amsterdam, who died between 2005-2009 (midyear 2008) and 2017-2019 (midyear 2018), with complete data for 162 and 124 decedents, respectively. Health conditions included functional limitations, symptom severity, and low consciousness.

Average age at death increased from 81.0 (2008) to 83.5 (2018). 48 % of decedents were men. Cancer constituted 33 % of causes of death. Controlling for sex, age at death, and education, non-cancer decedents experienced more often low consciousness at 3 months before death in 2018 than in 2008. At 3 months in 2018, cancer decedents experienced fewer functional limitations than in 2008 and fewer than non-cancer decedents. In both periods, cancer decedents experienced steeper functional declines than non-cancer decedents. Trajectories of symptom severity were similar in cancer and non-cancer decedents in both periods.

In non-cancer decedents, but not in cancer decedents, the dying process was more protracted in 2018 than in 2008. Level and increase in symptom severity did not improve over time for both cancer and non-cancer decedents, suggesting that improvement of palliative care is warranted for both groups.