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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, or medications 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 end-of-life 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
A trigger that a person may be deteriorating and nearing the end of life is a ‘No’ response to the ‘Surprise Question’. This asks: Would I be surprised if this person were to die in the next few weeks or months?
Other possible indicators of deterioration include:
- increasing care needs
- choice for no further active care
- increasing physical or mental health concerns
- special condition-related clinical indicators.
SPICT (571kb pdf) or the simplified SPICT-4ALL (571kb pdf) tool can help in recognising signs that a person’s overall health may be declining.
Australia-modified Karnofsky Performance Scale (AKPS) (2.69MB pdf) to measure a person’s ability to perform their activities of daily living.
Recognising deterioration – a training video in the Education on the Run series.
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?
CareSearch is funded by the Australian Government Department of Health, Disability and Ageing.
Updated May 2025
Page updated 21 July 2026
- Supporting Services
- palliAGED Products
- Practice Tip Sheets for Nurses
- Recognising Deterioration