Abstract
rate of overall deterioration is an important indicator of prognosis. Patients are particularly at risk of dying from aspiration pneumonia, urinary tract infections, complications from falls and fractures, and sepsis secondary to pressure ulcers. These are all commoner the more advanced the disease. Even so, some very disabled patients will live for many years while others may succumb quite suddenly from an episode of sepsis or, less commonly, from a pulmonary embolus. The unpredictable disease trajectory makes planning for the terminal event particularly difficult and most patients die in hospital rather than at home. 7
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