Trajectories of psychological and social well-being preceding death

Poorer psychological and social well-being has been linked to increased mortality.

To delineate the trajectories of psychological and social well-being during the last two decades of life.

Within the Rush Memory and Aging Project, 1971 older adults were followed up for up to 22 years. Aspects of psychological well-being (ie, depression symptoms, loneliness and purpose in life) and social well-being (ie, cognitive activity, social activity and social network) were annually measured through structured interviews. Survival status was tracked during the follow-up period. Data were analysed using Cox regression and mixed-effect models with a backward timescale.

During the follow-up, 1119 (56.77%) participants died. In multiadjusted Cox regression models, higher depression symptoms and poor social activity were associated with increased mortality. Compared with survivors, decedents showed steeper declines in psychological and social well-being, leading to significant differences up to 13 years before death for purpose in life (mean difference: -0.14 (-0.26, -0.01)), 9 years for depression symptoms (0.35 (0.10, 0.60)) and social activity (-0.16 (-0.26, -0.06)), 6 years for loneliness (0.13 (0.05, 0.21)), 4 years for social network (-1.06 (-1.77, -0.36)), and 3 years for cognitive activity (-0.12 (-0.21, -0.04)). Among decedents, the terminal phase began 11 years before death for purpose in life, 10 years for cognitive activity, 9 years for social activity and depression symptoms and 6 years for loneliness.

Psychological and social well-being may begin to exhibit terminal decline approximately 6-11 years prior to death. Longitudinal surveillance of well-being should be incorporated into the context of geriatric medical care.