Table 3 Prevalence of patients at risk of deteriorating and dying
n | % | |
|---|---|---|
General clinical risk of deteriorating health (n = 382) | ||
Two or more unplanned hospital admissions in the past 6 months | 1 | 0.3 |
Performance status is poor or deteriorating, with limited reversibility | 24 | 6.3 |
Dependent on others for care due to physical and/or mental health issues | 26 | 6.8 |
Significant weight loss over the past 3–6 months and/or a low body mass index | 18 | 4.7 |
Persistent symptoms despite optimal treatment of the underlying condition(s) | 16 | 4.2 |
The patient or family asked for palliative care, treatment withdrawal/limitation, or a focus on quality of life | 97 | 25.4 |
Disease-specific risk for the deterioration of the conditions | ||
Cancer (n = 14) | ||
Functional ability deteriorating due to progressive cancer | 3 | 21.4 |
Too frail for cancer treatment or treatment for symptom control | 2 | 14.3 |
Dementia/frailty (n = 56) | ||
Unable to dress, walk, or eat without help | 12 | 21.4 |
Eating and drinking less; difficulty swallowing | 9 | 16.1 |
Urinary and fecal incontinence | 13 | 23.2 |
No longer able to communicate using verbal language; little social interaction | 23 | 41.1 |
Fractured femur; multiple falls | 10 | 17.9 |
Recurrent febrile episodes or infections; aspiration pneumonia | 2 | 3.6 |
Neurological disease (n = 18) | ||
Progressive deterioration of physical and/or cognitive function despite optimal therapy | 7 | 38.9 |
Speech problems with increasing difficulty communicating and/or progressive difficulty swallowing | 2 | 11.1 |
Recurrent aspiration pneumonia; breathless or respiratory failure | 1 | 5.6 |
Cardiovascular disease (n = 38) | ||
NYHA Class III/IV heart failure or extensive, untreatable coronary artery disease with breathlessness or chest pain at rest or on minimal exertion | 4 | 10.5 |
Severe, inoperable peripheral vascular disease | 0 | 0.0 |
Respiratory disease (n = 13) | ||
Severe chronic lung disease with breathlessness at rest or on minimal exertion between exacerbations | 2 | 15.4 |
Needs long-term oxygen therapy | 1 | 7.7 |
Has needed ventilation for respiratory failure or ventilation is contraindicated | 0 | 0.0 |
Kidney disease (n = 5) | ||
Stage 4 or 5 chronic kidney disease (eGFR < 30 ml/min) with deteriorating health | 3 | 60.0 |
Kidney failure complicating other life-limiting conditions or treatments | 3 | 60.0 |
Stopping dialysis | 0 | 0.0 |
Liver disease (n = 3) | ||
Advanced cirrhosis with one or more complications in the past year: diuretic-resistant ascites | 0 | 0.0 |
Advanced cirrhosis with one or more complications in the past year: hepatic encephalopathy | 0 | 0.0 |
Advanced cirrhosis with one or more complications in the past year: hepatorenal syndrome | 0 | 0.0 |
Advanced cirrhosis with one or more complications in the past year: bacterial peritonitis | 0 | 0.0 |
Advanced cirrhosis with one or more complications in the past year: recurrent variceal bleeds | 0 | 0.0 |
Liver transplantation is contraindicated | 2 | 66.7 |