Please use this identifier to cite or link to this item: https://doi.org/10.11622/smedj.2016179
Title: Death among elderly patients in the emergency department: a needs assessment for end-of-life care
Authors: Pal, Rakhee Yash 
Kuan, Win Sen 
Koh, Yiwen
Venugopal, Kuhan
Ibrahim, Irwani 
Keywords: Science & Technology
Life Sciences & Biomedicine
Medicine, General & Internal
General & Internal Medicine
death
elderly
emergency department
end-of-life care
PALLIATIVE CARE
TRAJECTORIES
GUIDELINES
CLINICIAN
ILLNESS
Issue Date: 1-Mar-2017
Publisher: SINGAPORE MEDICAL ASSOC
Citation: Pal, Rakhee Yash, Kuan, Win Sen, Koh, Yiwen, Venugopal, Kuhan, Ibrahim, Irwani (2017-03-01). Death among elderly patients in the emergency department: a needs assessment for end-of-life care. SINGAPORE MEDICAL JOURNAL 58 (3) : 129-133. ScholarBank@NUS Repository. https://doi.org/10.11622/smedj.2016179
Abstract: © 2017, Singapore Medical Association. All Rights Reserved. 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 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 ED deaths in patients aged ≥ 65 years 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 the available information, their Karnofsky Performance Status (KPS) scores and trajectories of dying were ascertained. Results In one year, 197 patients aged ≥ 65 years 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 pre-existing 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 these patients 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.
Source Title: SINGAPORE MEDICAL JOURNAL
URI: https://scholarbank.nus.edu.sg/handle/10635/156727
ISSN: 0037-5675
DOI: 10.11622/smedj.2016179
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