Approaching the end of life

The General Medical Council defines patients approaching the end of life are those who are likely to die within the next twelve months. Emergency physicians may encounter four different patient trajectories during this final year, each of which requires different approaches9,10.

  • Sudden/imminent death: abrupt decline after a catastrophic event such as an intracranial haemorrhage, major trauma, or a ruptured aortic aneurysm.
  • Terminal illness: long history of illness, ending in a relatively rapid decline in function. Many cancers follow this pathway.
  • Organ failure: overall gradual decline, with intermittent exacerbations, following which the patient never regains their former baseline, such as in COPD or heart failure.
  • Frailty: slow steady functional decline, seen in dementia or with advanced age. Patients may present with an abrupt intervening deterioration due to events such as sepsis or trauma.
Figure 1: Trajectories at the end of life11