Background Physical, cognitive, and psychological conditions are associated with an increased risk of mortality, yet few studies have characterized terminal declines in these functional domains preceding death. In this multicohort study, we examined both separate and joint trajectories of physical, cognitive, and psychological functioning during the final decade of life and assessed the role of socioeconomic status (SES). Methods We used data from three national cohort studies: the US Health and Retirement Study, the China Health and Retirement Longitudinal Study, and the Survey of Health, Ageing and Retirement in Europe. Physical, cognitive, and psychological functioning were assessed repeatedly using measures of activities of daily living, cognitive test performance, and depressive symptoms, respectively. Mortality information was obtained from proxy respondents or national death registries. Statistical analyses included linear mixed-effects models and group-based multi-trajectory models using a backward timescale. Results Among 79,305 participants (mean age 65.8 ± 10.3 years; 55.4% female), 12,135 (15.3%) died during the 10-year follow-up. Compared with survivors, decedents showed steeper and accelerated declines in physical (βdeath * time -0.354, 95% confidence interval [95% CI] -0.372 to -0.336) and cognitive (βdeath * time -0.077, 95% CI -0.092 to -0.063) functioning, and to a lesser extent in psychological functioning (βdeath * time -0.044, 95% CI -0.061 to -0.028). In joint trajectory analyses, decedents experienced varying degrees of decline in at least one functional domain, and rapid terminal decline in physical functioning was accompanied by low and worsening cognitive and psychological functioning. In addition, higher SES was associated with lower odds of membership in adverse co-decline patterns, particularly the trajectory characterized by rapidly declining physical functioning combined with low and worsening cognitive and psychological functioning (e.g., OR high SES 0.07, 95% CI 0.02 to 0.20). Conclusions During the final decade of life, functional loss in physical and cognitive domains was more common than decline in psychological functioning. Higher SES was less likely to be associated with more unfavorable multidomain co-decline patterns.

Functional decline in the final years of life: A multicohort study

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2026年7月10日

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Junjie Lin,
Mika Kivimäki,
Yue Zhang,
Yaguan Zhou,
Xiaolin Xu

摘要

Background

Physical, cognitive, and psychological conditions are associated with an increased risk of mortality, yet few studies have characterized terminal declines in these functional domains preceding death. In this multicohort study, we examined both separate and joint trajectories of physical, cognitive, and psychological functioning during the final decade of life and assessed the role of socioeconomic status (SES).

Methods

We used data from three national cohort studies: the US Health and Retirement Study, the China Health and Retirement Longitudinal Study, and the Survey of Health, Ageing and Retirement in Europe. Physical, cognitive, and psychological functioning were assessed repeatedly using measures of activities of daily living, cognitive test performance, and depressive symptoms, respectively. Mortality information was obtained from proxy respondents or national death registries. Statistical analyses included linear mixed-effects models and group-based multi-trajectory models using a backward timescale.

Results

Among 79,305 participants (mean age 65.8 ± 10.3 years; 55.4% female), 12,135 (15.3%) died during the 10-year follow-up. Compared with survivors, decedents showed steeper and accelerated declines in physical (β_{death * time} -0.354, 95% confidence interval [95% CI] -0.372 to -0.336) and cognitive (β_{death * time} -0.077, 95% CI -0.092 to -0.063) functioning, and to a lesser extent in psychological functioning (β_{death * time} -0.044, 95% CI -0.061 to -0.028). In joint trajectory analyses, decedents experienced varying degrees of decline in at least one functional domain, and rapid terminal decline in physical functioning was accompanied by low and worsening cognitive and psychological functioning. In addition, higher SES was associated with lower odds of membership in adverse co-decline patterns, particularly the trajectory characterized by rapidly declining physical functioning combined with low and worsening cognitive and psychological functioning (e.g., OR _{high SES} 0.07, 95% CI 0.02 to 0.20).

Conclusions

During the final decade of life, functional loss in physical and cognitive domains was more common than decline in psychological functioning. Higher SES was less likely to be associated with more unfavorable multidomain co-decline patterns.