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)
