Recognising Deterioration
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Tips for Nurses:
Recognising Deterioration

What it is: Deterioration refers to signs of a person’s decline or reduced state of health. They may become bedbound, spend more time sleeping or resting, have reduced intake of food, difficulty with swallowing or fluctuating consciousness.

Why it matters: Recognising that a person is deteriorating is important for:

  • the review of care needs and goals of care with the person (if able), the family and GP
  • starting a palliative care plan or pathway
  • ensuring care is given in line with their wishes
  • managing symptoms appropriately
  • withdrawing treatments, activities, medication that are no longer appropriate or beneficial
  • providing counselling and support, to the person, the family and staff
  • avoiding inappropriate hospital transfers.

Nurses have a major role in each of these activities.

What I need to know: Recognising deterioration can mean different things to different people including the:

  • person’s health is declining
  • person has months of life left
  • person is actively dying.

It is common to think of the terminal phase of care as being short (e.g., cancer) but for conditions like dementia and organ failure, it can extend over months or years. Signs of decline should be recorded so that care plans can be implemented or changed to meet needs.

Many people experience deteriorating health over a long period. People who are declining may have episodes of decline followed by partial improvement and even times when death is expected but does not take place.

Loss of swallowing ability is an inevitable part of deterioration.

Actions

 


Possible indicators of deterioration include when the person:

  • has lost a noticeable amount of weight over the previous few months or stays underweight
  • has general health that is poor
  • following illness, does not return to previous level of health
  • displays decreased activity and a reluctance to engage
  • needs help from others for care due to increasing physical and/or mental health concerns
  • has troublesome symptoms most of the time despite appropriate management of their health concerns
  • has unplanned (emergency) transfer(s) to hospital.
 

Tools

Tools that may be useful include:

Three triggers that a person may be deteriorating and nearing the end of life:

  • If the answer is ‘no’ to the question ‘Would you be surprised if this patient were to die in the next few months or weeks?’
  • possible general indicators of deterioration are increasing care needs, choice for no further active care, increasing physical or mental health concerns
  • special condition-related clinical indicators.

SPICT (315kb pdf) or the simplified SPICT4ALL (317kb pdf) tool can help to recognise signs that a person’s overall health may be declining.

The Australian modified Karnofsky Performance Scale (AKPS) (37kb pdf) to measure a person’s ability to perform their activities of daily living.

 

My reflections:

 

How often do I assess people in my care for signs of deterioration?

 

How do careworkers in my team report to nursing/supervisory staff any changes in health of the clients or residents?

See related palliAGED Practice Tip Sheets:

Case Conferences

End-of-Life Care Pathway

Frailty


 

For references and the latest version of all the Tip Sheets visit www.palliaged.com.au/PracticeTipSheets

 

CareSearch is funded by the Australian Government Department of Health and Aged Care.
Updated July 2022

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