Because of the lack of specific indicators for the end-of-life time frame, it is not clear what is encompassed in end-of-life care. Frequently, people assume that end-of-life care is providing comfort care and
holistic care to dying patients and their family in a time frame of days to weeks when they are actively dying.
But if end-of-life care is framed only by the brief time interval before actual death, many patients would be
left without receiving adequate end-of-life care because their time frames are not well predicted. In greatly
aging societies such as Japan, many older adults are going through one of the two trajectories that make it
difficult to determine when they enter the end of life and predict approaching death. How about a relatively
healthy older adult who does not have significant life-threatening illness but has concerns about approaching death because of his or her advanced age? Does this person need end-of-life care? Current definitions
related to end-of-life care are mostly based on the time to death and stage of illness. But there are many
people without a prognosis of how much time is left and who do not think they have terminal illness but
are actually facing end of life and need end-of-life care from nurses. Because they may not have an obvious
medical diagnosis leading to imminent death, physicians whose focus is treating a specific disease may not
be able to provide adequate care that the patient needs regarding end of life. On the other hand, nurses who
see a patient’s life as a whole are better situated to understand the patient’s condition and concerns and guide
them to examine and prepare for end of life. In order for nurses to identify these people and provide the care
they need, end-of-life care should not be defined from a medical perspective based on the presence of a terminal illness or estimated time remaining but from the nursing perspective based on a broader view of life
and journey toward the inevitable end of life.