Long-term trajectories of memory, depression, and mobility independence before death: a multi-cohort study

Why the Last Years of Life Matter

Many families notice that an older loved one seems to "slip" in memory, mood, and independence before they pass away. This study asks a simple but important question: do these changes follow a predictable pattern, and can they signal when someone is nearing the end of life? By tracking thousands of older adults across several countries, the researchers mapped how memory, depression, and everyday abilities typically change in the years leading up to death.

Following Older Adults Around the World

The team combined data from four long-running studies of aging in China, England, the United States, and Europe. Together, these projects regularly interview and test tens of thousands of adults as they grow older, asking about their memory, mood, and ability to manage daily tasks such as dressing, bathing, shopping, cooking, taking medicines, and handling money. The researchers focused on people who had at least three rounds of measurements and compared those who later died with similar people who were still alive at the same time point. Instead of counting forward from midlife, they "turned time around" and lined up everyone by how many years they were from death or from their last check-in.

How Memory Changes Before the End

Across all four regions, memory gradually worsened with age for everyone, but a clear pattern emerged: people who were closer to death showed a sharper drop. In the Chinese group, for example, memory scores for those who died started to fall much more quickly about three years before death, after looking similar to survivors for many years. Similar, though slightly different, patterns appeared in the English, American, and European groups, with steeper memory loss in the final years of life nearly everywhere. Among all the measures studied, memory decline turned out to be the strongest single sign that a person was on a path toward death.

Mood and Everyday Abilities on a Downward Slope

The study also traced changes in depressive symptoms and two types of daily functioning. Feelings linked with depression, such as sadness, low energy, and poor sleep, tended to rise slowly over time but increased more noticeably in the last few years before death, often peaking one to two years before the end. Basic self-care tasks like bathing, dressing, and walking across a room started to show differences between those who died and those who survived as early as seven years before death in China and even earlier in the U.S. More complex tasks, such as shopping, preparing meals, and managing money, showed a more gradual worsening, with steeper decline in roughly the last four to five years. Overall, people who eventually died lost independence more quickly than their peers who were still alive.

Shared Patterns Across Different Countries

Although the four studies differed in culture, health care systems, and follow-up length, the big-picture story was similar. In every region, memory, mood, and daily functioning all changed more rapidly as people neared death, a phenomenon sometimes called "terminal decline." The exact timing and steepness of the curves varied, but the direction did not. These patterns likely reflect underlying biological changes—such as chronic illness, inflammation, and brain disease—rather than short-lived setbacks. The results suggest that paying attention to how quickly someone is changing may be more informative than a single test score taken at one moment in time.

What This Means for Families and Care

To a layperson, the main message is that noticeable, speeding-up problems with memory and everyday independence are not just "normal aging"—they can be early warning signs that a person is entering the final phase of life. Among these warning signs, a marked drop in memory performance stands out as the most powerful signal, followed by growing trouble with basic self-care. Recognizing these trends years in advance could help families and health systems plan better: scheduling more frequent checkups, offering support for mood and daily tasks, and having timely conversations about future care and end-of-life wishes.

Citation: Jiao, J., Guo, J., Shen, J. et al. Long-term trajectories of memory, depression, and mobility independence before death: a multi-cohort study. Transl Psychiatry 16, 221 (2026). https://doi.org/10.1038/s41398-026-03997-5

Keywords: cognitive decline, older adults, activities of daily living, depression in aging, mortality risk