BACKGROUND A critical step towards successful aging is to identify opportunities for prevention of functional decline. Our aim was to describe the heterogeneity in trajectories of dependency preceding death in elders and to identify factors associated with this heterogeneity. METHODS The study relied on 3,238 participants of the prospective population-based PAQUID cohort aged 65+ at baseline in 1988. Dependency was defined from an 11-item scale of basic and instrumental activities of daily living (ADL: bathing, dressing, toileting, continence, eating, and transferring; IADL: telephoning, shopping, using transport, handling medication and managing finances) collected over 22 years. Heterogeneous trajectories were estimated using a longitudinal item response theory model including latent classes. RESULTS Five distinct profiles of functional dependency were identified over the two last decades of life: persistently high (12%), moderate (26%), persistently low (40%), and accelerated high dependency (15%), and no dependency (8%). Main factors associated with heterogeneity included age at death, sex, education, initial cognition (MMSE score and dementia), initial disability and poly-medication. CONCLUSIONS In the two last decades of life, more than nine elders in ten were characterized as functional decliners. On average, around half of the elders died with no or mild dependency, whilst 27% live several years with a high level of limitations and would need assistance in activities of daily living, at least for 2 to 4 years preceding death. The identified factors associated with these trajectories are important to understand functional heterogeneity in elders and to propose interventions to postpone or prevent "chronic" disability.

中文翻译：

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老年人的异类长期依赖轨迹：PAQUID队列，一项基于人口的22年研究。

背景技术成功衰老的关键步骤是确定预防功能衰退的机会。我们的目的是描述老年人死亡之前依赖轨迹的异质性，并确定与这种异质性相关的因素。方法这项研究以1988年基线时年龄在65岁以上的以人口为基础的前瞻性人群队列研究的3238名参与者为依据。依赖项是从11个项目的日常生活基本和工具活动量表中定义的（ADL：洗澡，穿衣，上厕所，节制饮食） ，饮食和转移； IADL：过去22年收集的电话，购物，使用交通工具，处理药物和管理财务）。使用包括潜在类别的纵向项目响应理论模型估计异构轨迹。结果在生命的最后两个十年中发现了五种不同的功能依赖性特征：持续高（12％），中度（26％），持续低（40％）和加速高依赖性（15％）以及无依赖性（ 8％）。与异质性相关的主要因素包括死亡年龄，性别，受教育程度，初始认知（MMSE评分和痴呆），初始残疾和多重药物治疗。结论在生命的最后二十年中，十分之九的老年人是功能下降者。平均而言，约有一半的老年人没有或有轻度依赖而死亡，而27％的老年人则生活在高度限制的状态下数年，并且在死亡前至少2至4年的日常生活活动需要援助。