Typology of ageing and its associations with the end of life and death among older adults in China: a longitudinal person-centred study.
Studies on ageing trajectories typically foreground intrinsic capacities and focus on frailty and mortality outcomes. Instead, research capturing aspects of people's living environment alongside individuals' capacities is limited. This study aimed to identify qualitatively distinctive ageing profiles among deceased older adults in China using individual-based and environment-based indicators. It further examined sociodemographic correlates of profile membership and investigated associations between these profiles and end-of-life and death-related outcomes.
This is a retrospective cohort study.
Individual level, longitudinal data from the Chinese Longitudinal Healthy Longevity Study (CLHLS) between 2008 and 2018 were analysed.
The study included older participants of the CLHLS (2008-2018) who died between survey waves (N=9755).
Ageing profiles were categorised using latent class modelling based on individuals' intrinsic capacity (functional, physical, cognitive, mental and social dimensions; 20 indicators) and environment characteristics (healthcare-related, financial and social aspects; 10 items). Sociodemographic correlates of profile membership included age, sex, education, marital status, living arrangement and residence location. End-of-life and death experiences were assessed by length of survival and functional status measured at the wave prior to death, pain at death and terminal delirium.
Within the study sample, four profiles emerged: healthy-and-supported (57%), cognitively-competent-but-functionally-dependent (12%), functionally-capable-but-cognitively-challenged (18%) and frail-and-support-lacking (13%). While profiles were primarily distinguished by functional and cognitive capacities and financial status, social participation was insufficient across all groups. Sociodemographic disparities (sex, education, marital status, living arrangement and residence) were associated with profile membership. The first and third profiles enjoyed a better quality of life in their final months. The healthy-and-supported adults were most prone to painful deaths in hospitals. The functionally capable participants most often died at home. The frail-and-support-lacking individuals were at the highest risk of terminal delirium.
The heterogeneity of ageing revolved around functional and cognitive capacities and economic/financial characteristics, the latter particularly salient for the frail-and-support-lacking group. The uniformly low social engagement observed across profiles highlighted the need for boosting overall social participation and developing community-level social services. Distinct end-of-life patterns emphasise the importance of targeted care strategies for rural and urban residents and interventions for delirium prevention.
This is a retrospective cohort study.
Individual level, longitudinal data from the Chinese Longitudinal Healthy Longevity Study (CLHLS) between 2008 and 2018 were analysed.
The study included older participants of the CLHLS (2008-2018) who died between survey waves (N=9755).
Ageing profiles were categorised using latent class modelling based on individuals' intrinsic capacity (functional, physical, cognitive, mental and social dimensions; 20 indicators) and environment characteristics (healthcare-related, financial and social aspects; 10 items). Sociodemographic correlates of profile membership included age, sex, education, marital status, living arrangement and residence location. End-of-life and death experiences were assessed by length of survival and functional status measured at the wave prior to death, pain at death and terminal delirium.
Within the study sample, four profiles emerged: healthy-and-supported (57%), cognitively-competent-but-functionally-dependent (12%), functionally-capable-but-cognitively-challenged (18%) and frail-and-support-lacking (13%). While profiles were primarily distinguished by functional and cognitive capacities and financial status, social participation was insufficient across all groups. Sociodemographic disparities (sex, education, marital status, living arrangement and residence) were associated with profile membership. The first and third profiles enjoyed a better quality of life in their final months. The healthy-and-supported adults were most prone to painful deaths in hospitals. The functionally capable participants most often died at home. The frail-and-support-lacking individuals were at the highest risk of terminal delirium.
The heterogeneity of ageing revolved around functional and cognitive capacities and economic/financial characteristics, the latter particularly salient for the frail-and-support-lacking group. The uniformly low social engagement observed across profiles highlighted the need for boosting overall social participation and developing community-level social services. Distinct end-of-life patterns emphasise the importance of targeted care strategies for rural and urban residents and interventions for delirium prevention.