Approaches to the End of Life: Disease Trajectories

Chapter 4 provides a primer on the five terminal disease trajectories patients in the U.S.A. follow at the end of life: Sudden Death, Catastrophic Event, Organ Failure, Cancer, and Frailty/Dementia. The chapter explores the concept of disease as an ever-evolving process, not just a moment in time, and how recognizing the patterns of end-of-life decline can help anticipate what comes next. Bringing each trajectory to life with patient vignettes, the chapter highlights the human dimension of disease and its impact on the daily lives of patients and families. The chapter covers the most common diagnoses patients follow within each of the terminal trajectories, including coma, stroke, heart failure, lung failure, liver failure, kidney failure, cancer, age-related decline, and dementia. Emphasizing the need for ongoing assessment and a functional status evaluation for every patient, especially those with terminal disease, the chapter provides a framework for recognizing the bigger picture of disease progression and decline.