The trajectory of functional decline over the last 4 months of life in a palliative care population: A prospective, consecutive cohort study

SAGE Palliative Medicine & Chronic Care

This episode features Deidre Morgan (Palliative and Supportive Services, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia). Functional decline can be anticipated for people with life-limiting illnesses. Trajectories of functional decline differ in shapes and patterns. Understanding patterns of functional decline has implications for patient care and design of responsive health services.

This prospective study identifies two contemporary trajectories of functional decline for patients receiving specialist palliative care in the last 120 days of life. Precipitous deterioration in functional decline for cancers, solid organ failure and cardiovascular disease occurs as cohorts of patients approach Australia-modified Karnofsky Performance Status (AKPS) of 40. The pattern of functional decline for the neurological and dementias cohorts is flatter, showing a prolonged period of low function.

Study findings highlight that different types of care responses and resource allocation may be needed at different time points in different trajectories. This may require rapid mobilisation of carer support and modification of care plans preceding a precipitous functional decline (Trajectory 1). Extended periods of support to maintain patient function and support carers are required for those with a prolonged slow rate of functional decline (Trajectory 2). Full paper available from: https://journals.sagepub.com/doi/full/10.1177/0269216319839024 If you would like to record a podcast about your published (or accepted) Palliative Medicine paper, please contact Dr Amara Nwosu: [e-mail]