Respond to Deterioration
What does responding to deterioration look like in practice?
The Respond to Deterioration page of the ELDAC Care Model explains the key points in preparing for and responding to deterioration, including identification and recognition of deterioration, ensuring timeliness of response, and working within the care team to appropriately respond.
What is my role as a primary care professional in responding to deterioration?
Responding to deterioration requires significant clinical judgement, aligned to the older person’s goals of care and/or advance care directives.
Early identification of condition trajectory is critical to ensuring that deterioration is responded to and managed appropriately – as the primary care professional, you have a strong knowledge of their previous clinical history and symptoms to identify abnormalities and drive person-centred care.
For example, it is important to recognise when deterioration is most likely due to untreatable causes, such as disease progression, or when the possible treatments are not wanted, or are burdensome or inappropriate.
Additionally, you may be coordinating the care team and identifying when and where to refer. However, knowing when to refer is just as important as knowing when not to refer.
We want you to be equipped to:
- Understand your roles and responsibilities as a primary care professional in responding to deterioration.
- Confidently identify what disease trajectory the older person may be experiencing to appropriately plan and provide care through reassessment and guidance provided by goals of care and/or advance care directives.
- Support the older person and their families by providing information and resources on what to expect with changes in condition associated with deterioration.
The deteriorating patient
CareSearch
This webpage provides a summary of considerations for recognising and responding to deterioration.
Background Report to the Palliative Care Service Development Guidelines: Illness trajectories and dying (741kb pdf)
Palliative Care Australia
People receiving palliative care will experience different illness trajectories depending on the primary diagnosis and presence of other diseases (co-morbidities). Palliative Care Australia identifies that there are three common trajectories of illness for people with a life-limiting illness:
- Short period of evident decline - these clients may have good function for a long period followed by a few weeks or months of rapid decline prior to death.
- Long-term limitations with intermittent serious episodes - these clients will have gradual decline in function. During each acute episode, the client is at risk of dying but they may not. However, function will continue to decline.
- Prolonged dwindling - the client has a long-term progressive disability and reduction in function. Death may be caused by infections, falls or fractures.
Across all of these illness trajectories it is important to identify and respond appropriately to deterioration of the older person caused by their primary diagnosis or as a result of other or confounding co-morbidities or events.
Support for the older person, family and carer
ELDAC Primary Care Toolkit
This section of the Primary Care Toolkit provides a summary of resources on palliative and end-of-life care to provide to the older person, their family and carer to support them, as well as how to develop feedback mechanisms for ongoing improvement, and providing care to diverse populations.