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 commencement of a palliative care plan or pathway.
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 their 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. This includes increasing symptoms, 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

Typical Illness Trajectories. Available at The Royal Australian College of General Practitioners Silver Book https://www.racgp.org.au/silverbook

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. 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 contacted when an older person is deteriorating.

How to respond to deterioration in residential aged 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

reduced activity

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.

The palliAGED Recognising deterioration in a resident short video clip provides a simple summary.

The 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 RAC 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. The tool can be used in situations of increased concerns when team members notice that something isn’t quite right.

Supporting continuity of care will include:

Accessing after hours medical care to ensure appropriate care at all times. In some states and territories acute hospital services have rapid response teams that may offer phone support or provide 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 in the event that 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.

Liaising with the hospital following transfer to support the older person’s return if their condition stabilises (dependent on their preferences). If you are able to provide the care required for the older person, discuss this with the hospital staff. For more information, palliAGED has Practice Tips on continuity of care for Nurses (pdf) and Careworkers (pdf)).
How to build knowledge, confidence and skills to respond to deterioration in residential aged care
- - Gain a better understanding about delivering palliative and end-of-life care by listening to the ELDAC podcast series ‘The What to do, When and How’.
  - Watch the ELDAC Residential Aged Care Toolkit Manage Dying educational video. It also discusses how to respond to an older person in residential care who is declining in health.
  - Read the palliAGED Practice Tips on:
    - Recognising deterioration for Nurses (242kb pdf) and Careworkers (319kb pdf). Complete your reflections on the second page.
    - How to support families through an older person’s decline for Nurses (231kb pdf) and Careworkers (323kb pdf). Complete your reflections on the second page.
  - Complete the palliAGED online learning module on Recognising deterioration.
  - Know the options for after-hours support to be well prepared if an older person in your care requires emergency review. Undertake a simple quality improvement activity to map local options for after-hours support and consultation. These options may include rapid response teams or extended care paramedics.

References
1. The 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 (last revised Apr 2025), 5th edition. [cited 15 April 2025].
2. Murray SA, Kendall M, Boyd K, Sheikh A. Illness Trajectories and Palliative Care (pdf). British Medical Journal 2005. 330(7498):1007–1011. DOI: 10.1136/bmj.330.7498.1007.

Page updated 25 September 2026

Respond to Deterioration

Typical Illness Trajectories

How to respond to deterioration in residential aged care

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

References