Why is it important to recognise deterioration in aged care?
All aged care staff should have the skills to recognise deterioration and relay their observations in a timely manner to appropriate clinical staff. [1]
Recognising deterioration at the end of life supports health professionals to make appropriate changes to care and improve the quality of life for the older person and their families. [2, 3] Early recognition allows swift responses to managing pain and end-of-life symptoms.
Clinical skills and competencies that aged care nurses can apply when assessing and managing deterioration include:
- observational assessments (e.g., monitoring for falls, stroke and/or infections; behavioural changes; changes in eating patterns; talking about end of life), [3] and
- physical assessments (e.g., listening to the chest to detect early signs of pneumonia). [4]
Less obvious signs such as gradual weight loss and increasing fatigue may also indicate deterioration of an older person.
Want to learn more?
palliAGED has a page that goes into more detail about recognising deterioration. An online learning module is also available as part of palliAGED’s introduction modules.
ELDAC provides an overview of responding to deterioration, with links to relevant guidance available for the sector via their Primary Care, Home Care, Residential Aged Care, End of Life Law and Dementia Toolkits.
CareSearch also has information designated for GPs and nurses on recognising deterioration.
What can we do?
Tools and processes
Care teams:
- Get to know the older people in your care. This makes it easier to recognise changes and support them by addressing their preferences and needs e.g., by identifying and managing acute deterioration that may be reversible.
- Be aware of and use tools recommended by your organisation for recognising deterioration e.g., SPICT™, Surprise Question, Stop and Watch.
Organisations:
- Implement processes that support staff to recognise when an older person is approaching the end of life and/or requires palliative care (strengthened Aged Care Quality Standards, Action 5.7.1).
- Implement processes that recognise and respond to the rapidly changing needs of older people during the end of life (Action 5.7.4).
- Advocate for and/or implement tools to recognise deterioration and facilitate timely responses in care and improved outcomes.
The evidence:
- Evidence-based approaches to recognising changes at the end of life require the expertise of experienced healthcare professionals, and includes assessing signs and symptoms to ensure timely, individualised care. [5]
Training and education
Organisations:
- Provide staff members with education and resources to ensure they have adequate knowledge, skills, and confidence in recognising that an older person is approaching the end of their life.
The evidence:
- Some staff struggle to distinguish between stable residents and those nearing the end of life, causing difficulties in addressing care needs. [6]
- Inadequate clinical assessment competencies may prevent aged care staff in recognising the early signs of deterioration, which can then lead to further deterioration. [4]
Evaluation of quality of care, workload, and staffing
Organisations:
- Collect and analyse data from audits, evaluations, and feedback, which can be used to improve recognition of end of life and palliative care delivery.
- Review staff workload and resources that have implications for quality of care.
The evidence:
- The inability to recognise deterioration early in an older person may contribute towards undesirable outcomes such as potentially avoidable hospitalisation. [4] Unexpected deterioration has led to staff panicking and admitting the resident to hospital. [6]
- Falls, infections, and stroke are regarded as triggers for deterioration. [3] Monitoring for increased incidence of these events can therefore be useful.
- Exacerbating the need for further training is a lack of time and workload pressure / demands faced by nurses, who are necessary for timely assessment to determine whether someone is deteriorating. [4] Improving access to trained professionals and resources when providing care to older people who are deteriorating is important.