The Distribution and Determinants of End of Life Patterns to Death of Older Canadian Men: The Manitoba Follow-up Study

Abstract

Objectives: To determine the patterns of end of life well-being, and the determinants of these patterns in older men. Subjects: A cohort study of older men. Measurements: We reviewed medical and questionnaire data to define end of life trajectories using the WHO Quality of Life Framework. Predictors of these patterns were measured in 2006: medical conditions, baseline quality of life, quality of life trajectory from 1996 to 2006, and self-ratings of well-being. Results: The most common pattern was a gradual decline in well-being prior to death; about 1/5 men experienced a rapid decline, and about 1/5 men experienced a terminal drop; while 13% survived and 5% could not be classified. Lower baseline physical functioning and more chronic diseases was associated with a gradual decline to death. Conclusions: End of life patterns are heterogeneous and clinical and social care must adjust to this heterogeneity.

Keywords

cohort study epidemiology well-being quality of life/death

Get full access to this article

View all access options for this article.

References

Crimmins

E. M.

(2015). Lifespan and healthspan: Past, present, and promise. The Gerontologist, 55(6), 901–911. https://doi.org/10.1093/geront/gnv130

Fries

J. F.

(1980). Aging, natural death, and the compression of morbidity. New England Journal of Medicine, 303(3), 130–135. https://doi.org/10.1056/nejm198007173030304

Fries

J. F.

(2003). Measuring and monitoring success in compressing morbidity. Annals of Internal Medicine, 139(5 Pt 2), 455–459. https://doi.org/10.7326/0003-4819-139-5_part_2-200309021-00015

Gill

T. M.

Gahbauer

E. A.

Han

Allore

H. G.

(2010). Trajectories of disability in the last year of life. New England Journal of Medicine, 362(13), 1173–1180. https://doi.org/10.1056/NEJMoa0909087

Glaser

B. G.

Strauss

A. L.

(1968). Time for dying. Aldine Press.

Hanlon

Wightman

Politis

Kirkpatrick

Jones

Andrew

M. K.

Vetrano

D. L.

Dent

Hoogendijk

E. O.

(2024). The relationship between frailty and social vulnerability: A systematic review. The Lancet Healthy Longevity, 5(3), e214–e226. https://doi.org/10.1016/s2666-7568(23)00263-5

Lunney

J. R.

Lynn

Foley

D. J.

Lipson

Guralnik

J. M.

(2003). Patterns of functional decline at the end of life. JAMA, 289(18), 2387–2392. https://doi.org/10.1001/jama.289.18.2387

Mitnitski

Rockwood

(2016). The rate of aging: The rate of deficit accumulation does not change over the adult life span. Biogerontology, 17(1), 199–204. https://doi.org/10.1007/s10522-015-9583-y

Molnar

Frank

C. C.

(2019). Optimizing geriatric care with the GERIATRIC 5Ms. Canadian Family Physician Medecin de Famille Canadien, 65(1), 39.

10.

Olsen

C. F.

Bergland

Debesay

Bye

Langaas

A. G.

(2019). Striking a balance: Health care providers’ experiences with home-based, patient-centered care for older people—A meta-synthesis of qualitative studies. Patient Education and Counseling, 102(11), 1991–2000. https://doi.org/10.1016/j.pec.2019.05.017

11.

Palmore

Cleveland

(1976). Aging, terminal decline, and terminal drop. Journal of Gerontology, 31(1), 76–81. https://doi.org/10.1093/geronj/31.1.76

12.

Riegel

K. F.

Riegel

R. M.

(1972). Development, drop, and death. Developmental Psychology, 6(2), 306–319. https://doi.org/10.1037/h0032104

13.

Siegler

I. C.

(1975). The terminal drop hypothesis: Fact or artifact? Experimental Aging Research, 1(1), 169–185. https://doi.org/10.1080/03610737508257957

14.

Soysal

Veronese

Thompson

Kahl

K. G.

Fernandes

B. S.

Prina

A. M.

Solmi

Schofield

Koyanagi

Tseng

P. T.

Lin

P. Y.

Chu

C. S.

Cosco

T. D.

Cesari

Carvalho

A. F.

Stubbs

(2017). Relationship between depression and frailty in older adults: A systematic review and meta-analysis. Ageing Research Reviews, 36, 78–87. https://doi.org/10.1016/j.arr.2017.03.005

15.

St John

P. D.

Jiang

Tate

R. B.

(2018). Quality of life trajectories predict mortality in older men: The Manitoba follow-up study. Journal of Aging and Health, 30(2), 247–261. https://doi.org/10.1177/0898264316673714

16.

St John

P. D.

Tyas

S. L.

Montgomery

P. R.

(2013). Life satisfaction and frailty in community-based older adults: Cross-sectional and prospective analyses. International Psychogeriatrics, 25(10), 1709–1716. https://doi.org/10.1017/s1041610213000902

17.

StatisticsCanada. (2025). Health of Canadians (82-570-X). His Majesty the King in Right of Canada as represented by the Minister of Industry, 2025.

18.

Stolz

Gill

T. M.

Mayerl

Rásky

É.

Freidl

(2021). Trajectories of late-life disability vary by the condition leading to death. The Journals of Gerontology: Series A, 76(7), 1260–1264. https://doi.org/10.1093/gerona/glaa234

19.

Tate

R. B.

Cuddy

T. E.

Mathewson

F. A.

(2015). Cohort profile: The Manitoba follow-up study (MFUS). International Journal of Epidemiology, 44(5), 1528–1536. https://doi.org/10.1093/ije/dyu141

20.

Tate

R. B.

Lah

Cuddy

T. E.

(2003). Definition of successful aging by elderly Canadian males: The Manitoba follow-up study. The Gerontologist, 43(5), 735–744. https://doi.org/10.1093/geront/43.5.735

21.

Tate, R. B., Michaels, L., Cuddy, T. E., & Bayomi, D. J. (2013) Clinical diagnoses before age 75 and men's survival to their 85th birthday: The Manitoba follow–up study. The Gerontologist, 53(1), 133–141. https://doi.org/10.1093/geront/gns050

22.

Ware

J. E.

Jr. Sherbourne

C. D.

(1992). The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical Care, 30(6), 473–483. https://doi.org/10.1097/00005650-199206000-00002

23.

WHOQOLGroup. (1998a). Development of the World Health Organization WHOQOL-BREF quality of life assessment. Psychological Medicine, 28(3), 551–558. https://doi.org/10.1017/S0033291798006667

24.

WHOQOLGroup. (1998b). The World Health Organization quality of life assessment (WHOQOL): Development and general psychometric properties. Social Science & Medicine, 46(12), 1569–1585. https://doi.org/10.1016/S0277-9536(98)00009-4