Respond to Deterioration

Deterioration refers to signs of a person’s decline or reduced state of health. Being equipped to respond to deterioration quickly can:

Ensure needs are reviewed and care is provided, according to preferences and values.
Support assessment for the End-of-Life Pathway (pdf).
Ensure appropriate management of symptoms, interventions and medications.
Avoid unnecessary, unwanted or inappropriate transfers to hospital.
Facilitate support for the older person and their family and carers.

Typical Illness Trajectories

Older people will experience different illness trajectories depending on the primary diagnosis and presence of other diseases (co-morbidities). Three typical illness trajectories for people with progressive chronic illness are described and illustrated in the figure below: [1,2]

Trajectory 1: Cancer (short decline)

For these individuals there is a steady progression with a slight decline in physical health over months to years. Evident decline occurs in the end-of-life phase, which includes increasing symptoms and rapid decline in weight and functional status in the last weeks or months of life. [1,2]

Typical illness trajectories and palliative care phases towards the end of life

Reproduced with permission from: The Royal Australian College of General Practitioners. RACGP aged care clinical guide (Silver Book). 5th edition. East Melbourne, Vic: RACGP, 2019, 2020. Available at www.racgp.org.au/silverbook

It is important for clinicians and care workers to identify, plan, and be prepared to respond appropriately to deterioration across these illness trajectories. This may be caused by their primary diagnosis or as a result of other disease or events.

It is also important to distinguish between deterioration that is due to untreatable or irreversible causes like disease progression; and an acute or medical emergency that may be reversible, warrant review, and treatment. [3] Good clinical assessment and consultation with the older person’s GP is critical. If needed, external experts should be contacted, such as specialist palliative care. Family and carers should also be updated and included in ongoing discussions when an older person is deteriorating.

How to respond to deterioration in home care
Care workers may be the first to notice possible signs of deterioration, which may include:

poor general health, such as wounds or increasing fatigue

not returning to previous level of health after an illness

poor appetite

sleeping more

reduced activity including less engagement in social activities

increasing falls

needing additional help from others because of increasing health needs (physical or mental)

losing weight over months, or remaining underweight

unplanned emergency transfer/s to hospital.

palliAGED provide more information about recognising deterioration.

The Supportive and Palliative Care Indicators Tool (SPICT^TM) (pdf) can be used during routine care evaluations and following an unplanned hospitalisation. It may indicate a change in an older person’s condition that warrants a review of care needs. Refer to the ELDAC Home Care Toolkit Recognise End of Life section for further information.

The Stop and Watch Early Warning Tool (pdf) can be used by care workers to spot signs of deterioration in older people, and support escalation of concerns when staff notice that something isn’t quite right.

Supporting continuity of care will include:

Accessing after hours medical care to always ensure appropriate care. In some states and territories acute hospital services have rapid response teams that may be able to offer phone support or provide a consultation. Similarly, in some states and territories extended care paramedics may be available.

Enacting decision-making that is guided by the older person’s preferences and values. These can be expressed in an advance care plan or Advance Care Directive.

Ensuring clinical information accompanies the older person if an emergency department presentation and/or hospital admission is required. This includes legal documents identifying substitute decision-makers, advance care plans or an Advance Care Directive.

For more information, palliAGED has Practice Tips on continuity of care for Nurses and Careworkers).
How to build knowledge, confidence and skills to respond to deterioration in home care
Watch the ELDAC Home Care Toolkit Manage Dying educational video, which also discusses how to respond to an older person living at home who is declining in health.

Read the palliAGED downloadable Practice Tips on:

Recognising deterioration for Nurses and Careworkers. Complete your reflections on the second page.

How to support families and carers through an older person’s decline for Nurses and Careworkers.

Complete the palliAGED online learning module on Recognising Deterioration.

Review the SPICT^TM user guidelines to learn more about:

Assessing people’s needs and planning care

Talking about future care planning

Starting conversations about changes in health and care planning.

Gain a better understanding of the clinical indicators used in the SPICT^TM:

palliAGED offer information and resources to help understand comorbidity and multimorbidity.

palliAGED has practice tips on frailty for Nurses and Careworkers.

The ELDAC Dementia Toolkit provides information and guidance about people living with dementia at the end of life.

References
1. Royal Australian College of General Practitioners (RACGP). RACGP Aged Care Clinical Guide (Silver Book): Part A. Palliative and End-of-Life Care. Melbourne, VIC (AU): RACGP, 2019, 2020 (updated online), 5th edition. [cited 17 Feb 2026].
2. Murray SA, Kendall M, Boyd K, Sheikh A. Illness Trajectories and Palliative Care [Clinical Review]. British Medical Journal 2005. 330(7498):1007–1011. doi: 10.1136/bmj.330.7498.1007. [cited 17 Feb 2026].
3. Therapeutic Guidelines. Therapeutic Guidelines Palliative Care. [cited 10 Feb 2026].

Respond to Deterioration

Typical Illness Trajectories

How to respond to deterioration in home care

How to build knowledge, confidence and skills to respond to deterioration in home care

References