The concept of a dying trajectory was first suggested by Glaser and Strauss in 1965 and refers to the change in health status over time as a patient approaches death. 13 Glaser and Strauss identified different "patterns" of dying - sudden death, lingering, certain to die on time, and the vacillating pattern.
Full Answer
What is death trajectory?
Death trajectory refers to the pattern of dying when a patient is given a projected death date with limited or no medical recourse for the remaining existence of the individual's life. The death trajectory is dependent on the cause of death, whether it is sudden death, chronic illness, or the steady decline in health due to senescence (aging).
What are the possible trajectories of illness?
Some illnesses might follow none, any, or all of the trajectories: a severe stroke could, for example, result in sudden death or a fairly acute decline as in trajectory 1; a series of smaller strokes and recovery could mimic trajectory 2; while a gradual decline with progressive disability could parallel trajectory 3.
Why is it important to understand and consider trajectories?
Understanding and considering trajectories may help professionals take on board, at an earlier stage than would otherwise be the case, that progressive deterioration and death are inevitable.
What is the trajectory of cancer patients?
This trajectory is most common among patients living with an illness that can be categorized as leading to terminal, such as cancer. Functioning remains fairly high throughout the course of illness and then patients rapidly decline weeks or sometimes even days before death.
What is chronic malady?
What is a high or normal level of functioning?
What is the death trajectory?
What is the term for when a patient has an estimated death date?
What is sudden death?
Who first studied the premature death trajectory?
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About this website
What is dying trajectory in psychology?
the rate of movement and the length of the passage from a life-threatening condition to death.
What factors influence a dying trajectory?
The death trajectory is dependent on the cause of death, whether it is sudden death, chronic illness, or the steady decline in health due to senescence (aging). Death trajectory is analyzed in two separate aspects: duration and shape.
What does trajectory of an illness mean?
A health trajectory describes the dynamic (changing) course of health and illness. A health trajectory shows the values of an indicator of health status expressed as a function of time.
What is cancer trajectory?
Cancer: A relatively stable period of physical function followed by an acute decline in the last few months of life. Multiple studies have supported this trajectory however, the timing of steep decline ranges between 1 to 5 months before death depending on the study (1,5-7).
How can you tell if a patient is dying?
Signs and symptoms that suggest a person may be in the last days of life include: signs such as agitation, Cheyne–Stokes breathing, deterioration in level of consciousness, mottled skin, noisy respiratory secretions and progressive weight loss.
What is the trajectory of heart failure?
Abstract. Patients with end-stage heart failure have a trajectory of illness characterized by an overall gradual decline in function punctuated by periods of symptom exacerbation followed by a return nearly to their baseline. These exacerbations are not predictable.
What does trajectory mean?
/trəˈdʒek·tə·ri/ physics. the curved path an object follows after it is thrown or shot into the air, or of an object that is traveling through space: The missile came in on a very low trajectory.
What is an example of a trajectory?
A familiar example of a trajectory is the path of a projectile, such as a thrown ball or rock. In a significantly simplified model, the object moves only under the influence of a uniform gravitational force field.
What is a person's trajectory?
countable noun [with supp] The trajectory of something such as a person's career is the course that it follows over time. ... a relentlessly upward career trajectory. Collins COBUILD Advanced Learner's Dictionary.
How quickly do cancer patients decline?
Most patients with metastatic cancer remain quite functional until approximately five to six months before their deaths. Their health statuses then tend to slowly decline until the rate of decline begins to accelerate rapidly two to three months before death.
When cancer spreads where does it go first?
When cancer spreads, it's called metastasis. In metastasis, cancer cells break away from where they first formed, travel through the blood or lymph system, and form new tumors in other parts of the body. Cancer can spread to almost anywhere in the body. But it commonly moves into your bones, liver, or lungs.
Which phases would a person experience during an illness trajectory?
Trajectory onset phase- occurs with the first onset of signs and symptoms and includes the diagnostic period. The acute phase- follows the crisis phase and refers to the period when the patient's symptoms can be controlled by a prescribed regimen. Stable phase - this phase starts once symptoms are controlled.
What are the factors that contribute to a decline in death rates?
Other factors responsible for low mortality rates in developed countries have been cleanliness of person and home, hygienic surroundings, pollution control, social security measures, balanced food, health consciousness, etc.
What major factor affects mortality?
The variables which show the highest disparity in mortality level are: natural region among the context variables, education of mother among the socioeconomic variables, and interbirth interval and maternal age at birth of their children among the biological ones.
What determines an individual's views on death?
We are influenced by how other people or groups respond to dying, death and loss. The meaning given to illness, dying and death in different cultures can influence how a person manages the experience. For example, culture can influence the family's role, communication patterns or feelings of optimism or fatalism.
What does patient trajectory mean?
The term trajectory refers not only to the pathophysiological process of a patient's disease state, but also refers to the total organ- ization of work done throughout all nurse and patient interactions and refers to the impact of patient care processes on those interactions and the organization” (2007, 912).
What is Illness trajectories - Meaning and definition - Pallipedia
Distinct illness trajectories have been described at the end of life for frailty/dementia, cancer, and organ failure (see reference below). These trajectories can provide a framework for addressing patient and family expectations of what will happen regarding their health.
Frailty trajectories to identify end of life: a longitudinal population ...
Background Timely recognition of the end of life allows patients to discuss preferences and make advance plans, and clinicians to introduce appropriate care. We examined changes in frailty over 1 year, with the aim of identifying trajectories that could indicate where an individual is at increased risk of all-cause mortality and may require palliative care. Methods Electronic health records ...
Five Trajectories - CSU Shiley Haynes Institute for Palliative Care
Five Trajectories - CSU Shiley Haynes Institute for Palliative Care
Age and time-to-death trajectories of change in indicators of cognitive ...
Mortality-related processes are known to modulate late-life change in cognitive abilities, but it is an open question whether and how precipitous declines with impending death generalize to other domains of functioning.
What is the most frequently investigated domain within the framework of TD?
The most frequently investigated domain within the framework of TD is that of cognitive decline, with 20 articles dealing with some aspect of this domain. Overall, declines in different cognitive domains were found to be significant predictors of mortality ( Lavery, Dodge, Snitz, & Ganguli, 2009; Thorvaldsson et al., 2008 ). The articles examined global cognitive decline as well as declines in specific cognitive functions, such as perceptual speed, episodic memory, semantic memory, or spatial ability, and found different time-points of change in rate of decline among these areas, varying from less than 3 years to over 14 years before death (see Supplementary Table 1 ). This variation was not only related to the specific function examined, but also to the specific measure used to assess it ( Supplementary Table 1) ( Batterham, Mackinnon, & Christensen, 2011; Gerstorf, Ram, Hoppmann, Willis, & Schaie, 2011; Wilson, Beckett, Bienias, Evans, & Bennett, 2003 ), and to background characteristics, such as education ( Batterham et al., 2011; Terrera, Minett, Brayne, & Matthews, 2014 ). For example, using a specific combination of tests from different cognitive domains to measure cognitive decline ( Wilson et al., 2007; Wilson et al., 2003; Wilson, Leurgans, Boyle, Schneider, & Bennett, 2010 ), studies found the onset of TD to be between 3.5–4.5 years before death, whereas studies using the Mini-Mental State Examination (MMSE) reported onset of change in rate of decline as 6.2, 7.1, and 7.7 years before death ( Batterham et al., 2011; Muniz-Terrera, van den Hout, Piccinin, Matthews, and Hofer, 2013 ). This difference may be due to the MMSE being a more general screening tool than other measures. It may also be due to the specific populations tested. The research on whether education affects these processes by providing cognitive reserve, thereby either decreasing the rate of decline in cognitive performance or resulting in a higher predeath cognitive function, is as yet inconclusive. However, the preponderance of the evidence suggests that education does not decrease the rate of TD ( Cadar et al., 2016; Terrera et al., 2014; Muniz-Terrera et al., 2013 ), and Gerstorf et al. (2011) and Hülür, Infurna, Ram, & Gerstorf (2013) found steeper TDs in cognitive abilities in more recent cohorts, despite slower decline trajectories prior to the TD. Decline in some domains is also dependent on dementia ( Lavery et al., 2009 ), in that the proportion of persons with dementia in the sample may affect the findings. Specifically, those with dementia display significant global cognitive decline until death, whereas those without dementia manifest TD in specific cognitive tests, such as word fluency ( Laukka, MacDonald, & Bäckman, 2008 ). Finally, it remains unclear whether the decline is best represented as a linear or nonlinear function ( Sliwinski et al., 2006; Wilson et al., 2007 ).
How long does TD last?
TD was identified in diverse domains. Most findings focused on decline of cognitive abilities, and they reported this to occur 3–7 years prior to death. TD in wellbeing was found to begin 3–5 years prior to death. Trajectories by cause of death generally examined sudden death, terminal illness, organ failure, and frailty, and findings described differences in costs, function, and wellbeing, though examining a shorter predeath period than the TD literature.
How many papers have addressed the trajectories at the end of life?
We found 17 papers that specifically addressed the trajectories at end of life in relation to cause of death. Most research comparing trajectories focused on the last year, or even last months, of life ( Murtagh, Addington-Hall, & Higginson, 2011 ), although TD as described above usually starts earlier. Key dimensions distinguishing between the main trajectories are summarized in Table 1 and described below. Some studies examined trajectories in different ways; one such study compared characteristics of people in the following different groups: high-functioning, no decline; high-functioning, gradual decline; and low-functioning, steep decline ( Cosco, Stephan, Muniz, & Brayne, 2016 ).
How does cancer affect your life?
Patients tend to have symptoms that are initially vague and are only diagnosed later. In cancer, side effects of treatment make people feel more ill than they did before treatment ( Murray et al., 2007 ). Weight loss for cancer patients was found to accelerate significantly around 3 years before death ( Alley et al., 2010 ). Cancer patients also experience increases in functional dependence, anxiety, and depressive symptoms, and decreases in perceived social support in the last few months before death ( Tang et al., 2014 ). In the case of lung cancer patients and cardiac failure patients, social trajectories mirrored physical decline, while psychological and spiritual well-being decreased together at four key transitions (diagnosis, discharge after treatment, disease progression, and the terminal stage), swinging from hope to despair ( Murray et al., 2007 ). Social lives start to disintegrate because of others’ fears, and because treatment sets aside social plans. Thus, loneliness is common. Towards the terminal phase, the social world shrinks to family and then to self ( Murray et al., 2007 ).
What are the four domains of TD?
TD was investigated in four domains: cognitive, emotional well-being and life satisfaction, weight-loss, and physical function . Articles dealing with TD onsets (in years prior to death) in these domains are summarized in Supplementary Table 1. The cognitive domain is measured with tools such as memory tests, perceptual speed tests, and reading and numbering tasks ( Wilson et al., 2013 ); well-being is assessed by questionnaires measuring emotions, mental health, life satisfaction, and quality of life ( Gerstorf et al., 2014; Schilling, Wahl, & Wiegering, 2013; Wilson et al., 2013 ); and weight-los s and physical function through physical measurements and motor tests ( Alley et al., 2010; Wilson et al., 2012 ).
What causes sudden death?
(2003). Specific causes of death in this group vary more than in other groups; they include sudden cardiac failure, aneurysms, toxins , and accidents . In the study by Lunney et al. (2002), only 1% of this group died as hospital inpatients. Persons in this group were relatively younger (mean age = 73), more likely to be men (61%), and included more minorities (especially under the age of 75) than any of the other groups ( Lunney et al., 2002 ).
What is the principal summary measure used by articles on TD?
The principal summary measure used by articles on TD was the point in time before death when different functional domains showed accelerated decline. This pertained to cognitive, emotional, and physical function. The principal summary measures of trajectories by cause of death were: prevalence (of trajectory); expenditures and health services utilization; and rate of decline in function, health, cognition, and quality of life. We examine several explanations for differences in results across studies.
What is the trajectory of chronic illness?
Three distinct illness trajectories have been described so far for people with progressive chronic illnesses (fig 1)2-6: a trajectory with steady progression and usually a clear terminal phase, mostly cancer ; a trajectory (for example, respiratory and heart failure) with gradual decline, punctuated by episodes of acute deterioration and some recovery, with more sudden, seemingly unexpected death; and a trajectory with prolong ed gradual decline (typical of frail elderly people or people with dementia).
What is the primary goal of palliative care?
Optimising quality of life before a timely, dignified, and peaceful death are the primary aims of palliative care. Understanding and considering trajectories may help professionals take on board, at an earlier stage than would otherwise be the case, that progressive deterioration and death are inevitable.
What are the three trajectories of chronic disease?
Three typical illness trajectories have been described for patients with progressive chronic illness: cancer, organ failure, and the frail elderly or dementia trajectory
Why is it important to have a framework for care planning?
Such frameworks may help clinicians plan and deliver appropriate care that integrates active and palliative management. If patients and their carers gain a better understanding by considering illness trajectories this may help them feel in greater control of their situation and empower them to cope with its demands. An important implication for service planners is that different models of care will be appropriate for people with different illness trajectories. We review the main currently described illness trajectories at the end of life and draw out key clinical implications.
Why is it important to be aware of trajectories?
Being aware of these trajectories may help clinicians plan care to meet their patient's multidimensional needs better, and help patients and carers cope with their situation
What is the trajectory of cancer?
Trajectory 1: short period of evident decline, typically cancer. This entails a reasonably predictable decline in physical health over a period of weeks, months, or, in some cases, years. This course may be punctuated by the positive or negative effects of palliative oncological treatment.
What is the third trajectory of disability?
This third trajectory is of progressive disability from an already low baseline of cognitive or physical functioning. Such patients may lose weight and functional capacity and then succumb to minor physical events or daily social “hassles” that may in themselves seem trivial but, occurring in combination with declining reserves, can prove fatal.9,10This trajectory may be cut short by death after an acute event such as a fractured neck of femur or pneumonia. Box 3 illustrates this trajectory.
What is entry reentry death?
Entry-reentry deaths are used to describe persons whose illness trajectory is slower but they have periods of hospitalization and periods of better health. Glaser and Strauss were the first to begin to identify and describe these trajectories of how people die.
Why is it important for nurses to understand the trajectory of a patient?
In addition, it is important to understand the common experiences of people living with these various trajectories and the experiences of the family members who care for them . Nurses who care for patients at the end of life should have a basic understanding of the concerns common to people with certain types of illnesses. This will help the nurse better prepare for the care needs of these patients and their families.
What is the trajectory of dementia?
This trajectory is characterized by a slow decline towards death with low functional ability through the majority of their illness. These patients often live with progressive disability and require maximum assistance and care for a long period of time before their death. Patients with a general frailty and decline of all systems, such as with older adults afflicted with multiple conditions, can be categorized with this pattern. Patients diagnosed with dementia or Alzheimer’s disease also have a prolonged period of decline and low level of functioning. Patients with this type of trajectory often die from complications associated with being totally dependent in all activities of daily living. They have also been found to have higher rates of pressure ulcers and pneumonia from being bedbound and with prolonged use of feeding tubes (Rhodes, 2014).
Why is it important to educate patients and families about illness progression?
Educating patients and families is very important because these patients usually have a higher risk of sudden death (particularly with a cardiac diagnosis). These patients are also used to going to the hospital to get “fixed up” for exacerbations. Since this illness trajectory has a less predictable course than other trajectories, we never know if the next exacerbation could be the last. Assessing whether patients have an advance directive is very important because of the unpredictability of this type of trajectory. Since prognosis is not commonly talked about with these types of illnesses, patients might not be aware of their options and perhaps have not considered making an advance directive. Additionally, the risk of death following an exacerbation is great for this type of trajectory and often, as mentioned before, unexpected. Families may have a difficult time understanding why their loved one did not bounce back this time. It is important to educate patients and families about illness progression with this type of trajectory in a way that informs them but does not completely rob them of hope.
How long does cancer last before death?
Patients with this type of trajectory usually have some type of cancer. Their decline is typically short, often only a few weeks or days before they die. As you can see in Figure 2.1, the patient remains at a high level of function until that sudden sharp decline before death. One of the most important pieces of information that a nurse can give patients and families with this type of trajectory is that the end of life often comes quickly, without much warning. Most patients who are living with cancer receive treatment and diagnostic testing, followed sometimes by a break and then more treatment, and the cycle continues until the cancer goes into remission. If the cancer is at an advanced stage, there may be no break in treatment. Patients with end-stage cancer will usually continue their treatments until all curative options are exhausted, their lab values indicate that they are unable to receive further treatment due to low blood counts, or their cancer progresses despite all of the before mentioned interventions. It is often at the point at which the patient is informed that the cancer is spreading, or that there are no other treatment options, that the terminal decline towards death begins to happen. The important factor to explain to patients and families is that a person can be alright one day (or at least holding his own) and then bedbound the next day and actively dying. Thus the period of decline and disability is rapid and often chaotic if patients and families are uninformed that this commonly happens with this type of trajectory. Families of patients with this trajectory often take on the role of caregiver quickly and are usually aware that death is nearing and have the time to make amends and say good-bye. Taking on the caregiver role during this time instead of just being the patient’s spouse or son or daughter can cause emotional distress in family members. Depending on the setting, you can try to offer assistance with basic caregiving tasks, or perhaps institute a nursing assistant or tech to help the patient with those needs. This will help the family member to just be with the patient as the family member rather than as the caregiver.
What does "illness trajectory" mean?
In loose terms, trajectory means “course,” and therefore illness trajectory means “ course of illness.”. By understanding which type of illness trajectory a patient has, it will help to provide answers for two important and common questions many ...
What are the most common diseases that follow this type of progression?
This trajectory is very common among many people in this country who live with a chronic illness which will eventually progress to death. Heart failure and chronic obstructive pulmonary disease are the most common illnesses that follow this type of progression.
What is chronic malady?
Chronic malady trajectory. A chronic malady trajectory showing an overall decline in health with intermittent rises and falls in human function. The chronic malady trajectory occurs with types of death caused by autoimmune diseases such as HIV or other incurable illnesses. This process of death is characterized by an overall decline in health ...
What is a high or normal level of functioning?
People are at a high or normal level of functioning until the moment of death occurs. These types of deaths include fatal accidents and inconspicuous health issues like myocardial infarction or severe stroke. Deaths that align with a sudden death trajectory may happen over the course of a few days or in a matter of seconds.
What is the death trajectory?
Death trajectory refers to the pattern of dying when a patient is given a projected death date with limited or no medical recourse for the remaining existence of the individual's life. The death trajectory is dependent on the cause of death, whether it is sudden death, chronic illness, or the steady decline in health due ...
What is the term for when a patient has an estimated death date?
Medical care . When someone has an estimated death date and a death trajectory, the patient's caregivers generally cease curative care and proceed to provide palliative or comfort care. Curative care refers to situations where the patient still feels it is possible to use current medical care to recover or become stable enough to carry on with life.
What is sudden death?
Sudden or premature death occurs when the death of an individual is not perceived to be imminent. In a sudden death trajectory, an otherwise healthy and high-functioning individual will suddenly and unexpectedly die without any observable indications of oncoming demise. People are at a high or normal level of functioning until the moment ...
Who first studied the premature death trajectory?
Dying trajectories were first studied in the 1960s by two researchers, Barney Glaser and Anselm Strauss, in an attempt to understand the end of human life from different ailments, including cancer.
