![]() ![]() Although agreement exists among researchers that terminal decline is a within-person process and should be modeled as such, most previous attempts to identify its onset have assumed that all individuals experience a change in rate of decline at the same distance from death. Two issues emerging as critical in the terminal decline literature are whether terminal decline is detectable and, when detectable, whether it is possible to identify its onset. The terminal decline hypothesis proposes an association between proximity to death and cognitive decline suggesting that “years to live” or proximity to death may be better indicators of cognitive performance than chronological age before death ( Siegler, 1975). Our study suggests that terminal decline is a heterogeneous process, with its onset varying between individuals. Gender differences were found in rate of decline in the final stages of life. Education, age at death, and cognitive impairment at study entry were identified as modifiers of rate of change before and after change in rate of decline. Our results show that most individuals experience a period of slight decline followed by a much sharper decline. On average, the onset of a faster rate of change occurred about 7.7 years before death and varied across individuals. Differences in rate of change before and after the onset of change in rate of decline by sociodemographic variables were investigated. ![]() The random change point model fitted to MMSE scores structured as a function of distance to death allowed us to identify a potentially different onset of change in rate of decline before death for each individual in the sample. population-based longitudinal study of aging where almost all participants have died. We aimed at estimating the onset of faster rate of decline in global cognition using Mini Mental State Examination (MMSE) scores from participants of the Cambridge City over 75 Cohort Study (CC75C), a U.K. The terminal decline hypothesis states that in the proximity of death, an individual’s decline in cognitive abilities accelerates. ![]()
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