Citation

Yash Pal R, Kuan WS, Koh Y, Venugopal K, Ibrahim I. Singapore Med. J. 2016; 58(3): 129-133.

Affiliation

Emergency Medicine Department, National University Hospital, Singapore.

Copyright

(Copyright © 2016, Singapore Medical Association)

DOI

10.11622/smedj.2016179

PMID

27917433

Abstract

INTRODUCTION: Elderly patients with serious chronic diseases often present to the emergency department (ED) in the last moments of their life, many with identifiable trajectories of dying: organ failure; advanced cancer; and chronic frailty. These patients and their families may benefit more from good end-of-life (EOL) care provision than the standard resuscitative approach. This study aimed to determine the incidence and nature of death among patients aged 65 years and above in an ED, and characterise their trajectories of dying.

METHODS: This was a retrospective study carried out over a one-year period in a tertiary ED. All deaths in patients aged 65 years and above over this period were included. Information on the patients' demographics, comorbidities and details of death were extracted from the hospital's electronic medical records database. Based on available information, their Karnofsky Performance Status (KPS) scores and trajectories of dying were ascertained.

RESULTS: In one year, 197 patients aged 65 years and above died in the ED, 51.3% of whom suffered from serious chronic illnesses, with identifiable trajectories of dying. Of these patients, 46.5% had premorbid functional limitation with KPS scores of 0-40. However, only 14.9% of patients had a preexisting resuscitation status and 74.3% received aggressive resuscitative measures.

CONCLUSION: There is a significant burden of EOL care needs among elderly patients in the ED, many of whom have chronic illness trajectories of dying. This study underscores the need for improvement in EOL care provision for dying patients and their families in the ED.

Language: en