Typology of ageing and its associations with the end of life and death among older adults in China: a longitudinal person-centred study.

Four distinct ageing profiles were identified among deceased older adults in China using latent class modelling.

• Profiles were: healthy-and-supported (57%), cognitively-competent-but-functionally-dependent (12%), functionally-capable-but-cognitively-challenged (18%), and frail-and-support-lacking (13%).
• Classification was based on intrinsic capacity (functional, physical, cognitive, mental and social dimensions; 20 indicators) and environment characteristics (healthcare-related, financial and social aspects; 10 items).
• Sample included N=9755 older participants from the Chinese Longitudinal Healthy Longevity Study (CLHLS) who died between survey waves from 2008 to 2018.
• Profiles were primarily distinguished by functional and cognitive capacities and financial status.

Social participation was uniformly insufficient across all four ageing profiles.

• Low social engagement was observed across all profiles regardless of functional or cognitive status.
• This finding highlighted the need for boosting overall social participation and developing community-level social services.
• Social participation was included as one of the dimensions of intrinsic capacity assessed via 20 indicators.

Sociodemographic factors were associated with ageing profile membership.

• Sex, education, marital status, living arrangement, and residence location were all associated with profile membership.
• Age was also examined as a sociodemographic correlate of profile membership.
• These disparities were identified through analysis of the longitudinal CLHLS dataset spanning 2008–2018.

The healthy-and-supported profile was most prone to painful deaths in hospital settings.

• The healthy-and-supported group comprised the largest share of participants at 57% of the sample.
• Despite better quality of life in final months, this group had the highest likelihood of experiencing pain at death.
• Hospital death was the predominant place of death for this profile.

Functionally capable participants (functionally-capable-but-cognitively-challenged profile) most often died at home.

• This profile comprised 18% of the study sample.
• Members of this group enjoyed a better quality of life in their final months alongside the healthy-and-supported group.
• Home death was the most common end-of-life setting for this profile, suggesting distinct care pathway patterns compared to other groups.

The frail-and-support-lacking profile had the highest risk of terminal delirium.

• This profile comprised 13% of the study sample.
• Financial characteristics were particularly salient for this group in distinguishing it from other profiles.
• The elevated delirium risk in this group underscores the importance of interventions for delirium prevention in resource-limited older adults.

The first (healthy-and-supported) and third (functionally-capable-but-cognitively-challenged) profiles had better quality of life in their final months.

• Quality of life in the final period was assessed via functional status measured at the wave prior to death.
• End-of-life outcomes assessed included length of survival, functional status prior to death, pain at death, and terminal delirium.
• These two profiles contrasted with the cognitively-competent-but-functionally-dependent and frail-and-support-lacking groups in terms of end-of-life quality.

The study used a retrospective cohort design drawing on longitudinal data from the Chinese Longitudinal Healthy Longevity Study (CLHLS) spanning 2008 to 2018.

• The analytic sample comprised N=9755 older participants who died between survey waves.
• Ageing profiles were derived using latent class modelling.
• Individual-based and environment-based indicators were used jointly, capturing both intrinsic capacity and living environment characteristics.
• Intrinsic capacity covered functional, physical, cognitive, mental, and social dimensions (20 indicators); environment characteristics covered healthcare-related, financial, and social aspects (10 items).