Similar dynamics of terminal functional decline in nursing home residents with and without dementia

Objective: This study investigates the functional health trajectories at the end-of-life in nursing home residents with no dementia, mild-to-moderate dementia, and severe dementia. Methods: 45803 deceased residents (mean age 87.49ys ± 7.14ys, 67.6% female, no dementia (N=18993), mild-to-moderate dementia (N=14687), and severe dementia (N=12123)) from 357 nursing homes across Switzerland were included in this retrospective cohort study. Activities of daily living (ADL) scores of the Resident Assessment Instrument - Minimum Dataset (RAI-MDS) were used to assess functional health. Multi-phase growth models spanning 24 months prior to death were calculated as a function of dementia status and severity. Results: The functional health trajectories follow a nonlinear pattern with a long period of mild decline with mean ADL score change of -0.118 points per months (95% CI -0.122 to -0.114) for the no dementia group, followed by a significant terminal drop (mean ADL change of -1.528, 95% CI -1.594 to -1.462) two to three months before death (transition point at -2.221, 95% CI -2.306 to -2.136). Residents with dementia had a steeper pre-terminal decline (-0.026, 95% CI -0.32 to -0.20 for mild-to-moderate dementia, - 0.056, 95% CI -0.062 to -0.051 for severe dementia) and less terminal decline (0.274, CI 0.211 to 0.337 for mild dementia, -0.230 to 0.336 for severe dementia). However, the transition point and the pattern of decline were similar across the dementia groups, though proceeding at different levels. Conclusions: The dynamics of terminal functional health decline in nursing home residents with and without dementia are similar.