seven times out of ten. If not, talk to them and consider registration. If it would be a surprise to you if they were to live longer than 6-12 months, they are a high priority for talking and planning. General clinical indictors of deterioration and frailty The GSF Prognostic Indicator Guidance has details of clinical indicators by condition, but the presence of any of the following should trigger concern when associated with advanced age and / or disease: Limited self-care and interest in life: in bed or a chair more than 50% of their time. Breathless at rest or on minimal exertion (MRC scale 4/5). Progressive weight loss (&gt;10% over last six months). History of recurring or persistent infections and/or pressure ulcers. In cancer Metastatic disease should always trigger consideration of supportive care; WHO states that in cancer patients &gt;50% of time in bed or lying down gives a prognosis of fewer than three months survival. Triggers and opportunities Take the opportunity during routine consultations or visits to ask yourself the 'surprise' question and be alert to indicators of frailty and deterioration. You may then want to create an opportunity for a conversation you can plan in advance. A change in personal circumstances, particularly deterioration of a partner, can be a good trigger and opportunity to initiate a conversation. A clinical change, e.g. a new diagnosis, or a hospital visit. Feedback from a colleague, e.g. a district nurse concerned about a persistent pressure ulcer, or a discussion with a consultant