• Ken Hillman, Adrian G Barnett, Christine Brown, Leonie Callaway, Magnolia Cardona, Hannah Carter, Alison Farrington, Gillian Harvey, Xing Lee, Steven McPhail, Graves Nicholas, Ben P White, Nicole M White, and Lindy Willmott.
• Simpson Centre for Health Services Research, South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
• Intern Med J. 2024 Aug 1; 54 (8): 141414171414-1417.

AbstractThe current fallback position for the elderly frail nearing the end of life (less than 12 months to live) is hospitalisation. There is a reluctance to use the term 'terminally ill' for this population, resulting in overtreatment, overdiagnosis and management that is not consistent with the wishes of people. This is the major contributor to the so-called hospital crisis, including decreased capacity of hospitals, reduced ability to conduct elective surgery, increased attendances at emergency departments and ambulance ramping. The authors recently conducted the largest randomised study, to their knowledge, attempting to inform specialist hospital medical teams about the terminally ill status of their admitted patients. This information did not influence their clinical decisions in any way. The authors discuss the reasons why this may have occurred, such as the current avoidance of discussing death and dying by society and the concentration of healthcare workers on actively managing the acute presenting problem and ignoring the underlying prognosis in the elderly frail. The authors discuss ways of improving the management of the elderly nearing the end of life, such as more detailed goals of care discussions using the concept of shared decision-making rather than simply completing Advanced Care Decision documents. Empowering people in this way could become the most important driver of people's health care.© 2024 The Author(s). Internal Medicine Journal published by John Wiley & Sons Australia, Ltd on behalf of Royal Australasian College of Physicians.

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