Skip to content
Umbrella Aged Care
← Palliative and end-of-life care

Recognising that someone may be in the last year or months of life

GPs & clinicians Aged care staff Residents & families 7 min read

By Dr Josh Hatch, FRACGP

In residential aged care the last phase of life is often hard to see coming, because decline can be slow and uneven. Recognising it matters, because it is the point at which conversations, plans and medicines need to be in place. The Quality Standards require providers to have processes to recognise when a person needs palliative care or is approaching the end of life 3.

Numbers in the text link to the 3 sources listed at the foot of this page.

The surprise question

The surprise question asks: “Would I be surprised if this person died in the next 12 months?” It is quick, needs no tools, and has been used to identify people at high risk of death who might benefit from palliative care 13.

A 2017 systematic review pooled 16 studies with 11,621 seriously ill patients. When a clinician answered “no, I would not be surprised”, 37% of those patients died within 6 to 18 months. When the answer was “yes, I would be surprised”, 93% were still alive. Overall it identified 67% of the people who went on to die 13.

It performed worse in illnesses other than cancer, and most of the studies were at moderate to high risk of bias. The authors judged it poor to modest as a predictive tool 13. The pooled figures are not specific to residential aged care.

Read plainly, a “no” is a reason to have a conversation, not a forecast. Most residents flagged by the question will not die within the year, and some who are not flagged will.

Uncertainty is normal

Even when need is recognised, timing varies widely. Among Australian residents formally appraised as needing palliative care in 2021–22, half left permanent residential care within eight weeks of admission, while 22% were still there after two years 2.

That uncertainty is a reason to plan early, not to wait. Plans made while the person can still take part in them are more likely to reflect what they want.

Changes that prompt the question

None of these predicts timing on its own. Together, and over weeks to months, they are a reason to ask whether goals of care should be reviewed.

  • Spending more of the day in bed or asleep.

  • Eating and drinking less, or losing weight without trying.

  • Needing more help with walking, washing, dressing or eating.

  • Infections that keep coming back, or one hospital stay after another.

  • A long-term illness, such as heart failure, lung disease or dementia, that is no longer responding to treatment as it did.

  • The resident or family saying that things have changed.

Reversible decline

Not every decline is the last phase. A sudden change can come from an infection, dehydration, constipation, urinary retention, pain or a new medicine, and these can often be treated. Delirium in particular can look like dying. The Standards require providers to recognise and respond to delirium, including in the last days of life 3.

Recognising that a person may be in the last year of life and treating a reversible problem are not in conflict. Both belong in the same plan.

Related pages on this site

Sources cited on this page

  1. 2 Australian Institute of Health and Welfare. Palliative care services in Australia: palliative care for people living in residential aged care. (2021–22 data, appraisal under the Aged Care Funding Instrument; section last updated May 2023.) View source
  2. 3 Australian Government Department of Health, Disability and Ageing. Strengthened Aged Care Quality Standards (November 2025; implemented 1 November 2025). Outcome 5.7 Palliative care and end-of-life care, Actions 5.7.1 to 5.7.4. View source
  3. 13 Downar J, Goldman R, Pinto R, Englesakis M, Adhikari NKJ. The “surprise question” for predicting death in seriously ill patients: a systematic review and meta-analysis. CMAJ. 2017;189:E484–93. (16 studies, 11,621 patients; most at moderate to high risk of bias.) View source

See every source cited across the palliative and end-of-life care section →

Written by Dr Josh Hatch, FRACGP. General information only, reflecting his reading of the published evidence as at October 2026. It is not individual medical advice, does not create a doctor–patient relationship, and must not be used to start, stop or change any treatment. It is not legal advice. Evidence, Australian regulatory requirements and state laws on advance care planning, substitute decision-making and voluntary assisted dying change — always confirm current advice with the treating GP, the state health department or a lawyer.

This is general education, not a clinical protocol. The doctors who practise with Umbrella Aged Care are independent general practitioners, and each makes their own clinical decisions with the resident and family. Your GP’s advice for an individual may differ from what is written here. If it does, please ask them to talk it through with you.

Enquire about care