title: Death among elderly patients in the emergency department: a needs assessment for end-of-life care.
abstract: BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Emergency Medicine Department, National University Hospital, Singapore.
authors.forename: Rakhee
authors.initials: R
authors.lastname: Yash Pal
authors.affiliation: Emergency Medicine Department, National University Hospital, Singapore.
authors.forename: Win Sen
authors.initials: WS
authors.lastname: Kuan
authors.affiliation: Duke-NUS Medical School, Singapore.
authors.forename: Yiwen
authors.initials: Y
authors.lastname: Koh
authors.affiliation: Emergency Medicine Department, National University Hospital, Singapore.
authors.forename: Kuhan
authors.initials: K
authors.lastname: Venugopal
authors.affiliation: Emergency Medicine Department, National University Hospital, Singapore.
authors.forename: Irwani
authors.initials: I
authors.lastname: Ibrahim
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D002908:Chronic Disease; D015897:Comorbidity; D003643:Death; D057286:Electronic Health Records; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D017567:Karnofsky Performance Status; D008297:Male; D020380:Needs Assessment; D012189:Retrospective Studies; D012846:Singapore; D013727:Terminal Care
keywords: death; elderly; emergency department; end-of-life care