Assessing the Dying Patient

Key points

  • Recognising dying is the first step in terminal care management. If three or more of the following symptoms are present is likely the patient is entering the terminal phase.
    • ​Experiencing rapid day to day deterioration that is not reversible
    • Requiring more frequent interventions
    • Becoming semi-conscious, with lapses into unconsciousness
    • Refusing or unable to take food, fluids or oral medicines
    • Irreversible weight loss
    • An acute event has occurred, requiring revision of treatment goals
    • Profound weakness
    • Changes in breathing patterns
  • ​The duration of the terminal phase is hard to predict. It can range from short hours to many days. The family should be advised of this.
    • ​Cachexia, end-stage organ failure, or infection may be associated with a more rapid deterioration
    • Patients may survive for some days, even without fluids.
  • In patients with severe dementia and similar end-stage chronic conditions affecting the conscious state, it may be quite difficult to clearly identify the onset of the terminal phase.
  • The clinical priorities at this stage are:
    • Talk to patient and / or family
    • Address symptoms
    • Ensure needed medications are available
    • Advise other health professionals
    • Consider whether the patient is in residential aged care or at home, or if they have expressed a preference for admission to hospital or palliative care unit for end of life, and plan accordingly

Podcast: Recognising death

Recognising death
This is the first of three podcasts addressing end of life issues. The episode includes interviews with Dr Peter Saul, A/Prof Charlie Corke, and A/Prof Amanda Walker, talking about why and how we need to identify dying patients

For more information,

Ref: Royal Australasian College of Physicians – Pomegranate.  31 August 2015.

Pomegranate comes to you from the Learning Support Unit at the Royal Australasian College of Physicians. The program is presented by Camille Mercep and produced by Anne Fredrickson.

Last updated 21 February 2017