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.