Background Death is now an event of older age, and living with multiple long-term conditions – multimorbidity (MLTC-M) is now the norm in later life. People dying with MLTC-M report the same symptoms as people dying with cancer yet are seldom referred to specialist palliative care services. There is no consensus on how to identify people with MLTC-M approaching the end-of-life.

Aim To synthesise evidence on identification of older people with MLTC-M approaching the end-of-life.

Methods A systematic review with narrative synthesis was conducted. The review protocol was registered prospectively with PROSPERO (CRD:42022324986). Databases searched: Medline, CINAHL, EMBASE, Psychinfo and Scopus. Databases were searched for studies published during or after 2002, until 4th March 2022. Quality was assessed using NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. The population studied were adults >50 years old, with MLTC-M. The exposures of interest were prognostic tools based on weighted indices. The outcome of interest was prognostic ability of the weighted index studied.

Results 8479 articles were identified and screened. 28 studies were included, all of observational design. 7 tools based on weighted indices were identified: Charlson Comorbidity Index, Elixhauser Comorbidity Index, Charlson-Deyo Comorbidity Index, Multimorbidity Weighted Index- ICD-10, Cumulative Illness Rating Scale and Disease Burden Morbidity Assessment. Of the tools identified, the Charlson Comorbidity Index had the largest evidence base, and performed best. A higher score Charlson Comorbidity score was associated with increased likelihood of death within the next 12 months.

Conclusion This review provides healthcare professionals with an evidence-based assessment for prognosticating at the end-of-life for people with MLTC-M. This will inform advance care planning, treatment decisions and service provision for those with MLTC-M. Identification of people with MLTC-M nearing the end-of-life will facilitate the management of their symptoms, and improve their end-of-life care experiences.