BMJ  2007;334:511-513 (10 March), doi:10.1136/bmj.39127.653704.80

Analysis

Getting services right for those sick enough to die

Johns Hopkins University, Room 609, 624 North Broadway, Baltimore, MD 21205, USA, and RAND, Arlington, Virginia 22202, USA

A model based on common trajectories of illness and associated care needs would improve the care of people with serious illness in the last phase of life, say Sydney Dy and Joanne Lynn

The first 150 words of the full text of this article appear below.

Most people believe their lives will be relatively healthy, punctuated by episodes of illness that last no more than a few weeks. On the rare occasions that we think about dying, we imagine short and overwhelming illness in old age. Healthcare systems are designed as if disability and ill health were aberrations, rather than a phase that lasts months or years near the end of our lives, despite the contrary evidence all around us. Because of improvements in sanitation, lifestyle, and medical care, only a small proportion of people in developed countries now die suddenly.¹ Most serious chronic illnesses cannot be catered for adequately by traditional hospital and surgical services, and substantial restructuring is needed. The numbers of people living with serious chronic conditions in old age will double in the next two decades in the United States,² and similar trends will be seen in many other countries.³ Finding sustainable . . . [Full text of this article]

Summary points

The trajectories

Designing care to match trajectories

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