Illness trajectories in the age of big data

For decades, healthcare providers have understood that patients follow typical trajectories of health decline as they approach the end of life, and they have used this understanding to help patients and families anticipate the dying process. Traditional trajectories focus on function or overall health status and include sudden death, terminal illness (rapid and accelerating deterioration), organ failure (slower decline marked by periods of acute exacerbation and recovery), and frailty (slow decline with fewer acute changes).1

Two Education articles in the BMJ add novel dimensions to our understanding of health decline. Murray et al explain how declines in function do not always mirror declines in social, psychological, and spiritual dimensions. They also add a new trajectory, multimorbidity, to describe a person with conditions from multiple trajectories (such as heart disease from organ failure and cognitive impairment from frailty).2 Geijteman et al describe how …