A checklist of 29 items called CriSTAL (Criteria for Screening and Triaging to Appropriate aLternative care) can predict an elderly patient's chances of dying within 30 days, according to researchers at Australia's University of New South Wales. CriSTAL can help doctors determine at the time of hospital admission if a patient's death is imminent and unavoidable regardless of treatment.
"Current acute hospital systems often fail to recognize or cater to the needs of people for whom death is imminent and unavoidable," said lead researcher Dr. Magnolia Cardona-Morrell. "They are geared for aggressive treatment and emergency resuscitation, not peaceful, harm-free transitions," she said.
In the study, the researchers wrote: "Delaying unavoidable death contributes to unsustainable and escalating healthcare costs, despite aggressive and expensive interventions. These interventions may not influence patient outcome; often do not improve the patient's quality of life; may compromise bereavement outcomes for families; and cause frustration for health professionals."
Researchers examined published information to search for the most likely predictors of death in a month and also for the next 12 weeks.
The list of 29 predictors includes older age (at least 65 years old), cognitive impairment, abnormal heart monitoring results, and protein in the urine.
The researchers stress that the checklist is not intended to deny healthcare for sick elderly patients who are terminally ill, but instead to "provide an objective assessment and definition of the dying patient as a starting point for honest communication with patients and families about recognizing that dying is part of the life cycle."
"Elderly people who are dying need to be protected from heroic but intrusive live-saving hospital interventions that often only prolong suffering rather than enhance quality of remaining life," said Cardona-Morrell.
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