My Nanna lived until her late 80's but in her last year, she started to make some risky choices.

The decision for her to move into a nursing home was made after my aunts found her stoking her old wood-fired cooker with a four-foot-long log of wood. She was simply feeding in the log as it burned down.

White puzzle in the shape of a brain with a piece missing and the text: Recognising the signs of deterioration...

Now, it was probable that she felt justified in doing this, perhaps she could no longer chop the wood (although there was family around who could do this for her) but in a timber home this was just too risky and she obviously had lost the capacity to recognise this. She was starting to behave irrationally and that is one of the signs to keep an eye and ear out for as it could be an indicator that the person needs a dementia assessment or perhaps additional physical support. It’s an indicator of deterioration.

Once we reach a certain age, as each year passes our bodies deteriorate, often so gradually that we don't necessarily recognise the change, or we choose not to acknowledge it or any increased need for support. But ignoring these signs is not always the wisest path. Sometimes it leads to an older person ending up at increased risk of illness, injury, premature admittance to residential care or an untimely death.

If you work with seniors you might need to be the one who identifies and responds to the change or deterioration in a person you care for.

That's what we want to delve into today, recognising and responding to signs of deterioration.

One of the questions currently asked by quality assessors when reviewing the standard of care and services delivered by home care providers is: ‘How do you make sure your staff can recognise signs and symptoms of deterioration in a consumer's mental health, cognition or physical condition, their functioning or capacity and do they know how to respond appropriately?'

Apart from irrational decisions or behaviour that is out of character, what else are you looking for and what should you be doing?

Change in personality

Perhaps you've noticed that the person you are supporting is showing less interest in something that previously they were passionate about it. Maybe they have become withdrawn or have started to exhibit mood swings.

The brain controls personality and mood – any damage due to illnesses such as dementia or other injuries like strokes can result in changes to the person's personality.

Increased forgetfulness

Maybe you're visiting a person to provide services in their home and you start to notice bills piling up, mail and newspapers unopened, there appear to be multiples of the same items in the pantry or bathroom cupboard, and you know they had no hoarding tendencies previously. When you gently bring it up with the person they laugh it off and say someone must be coming into their home and putting the extra items there and of course they’ve been paying their bills – they drove to the post office only last week to pay them! The only problem is, you know they no longer drive and have no car.

While we all have times when we forget where we put the car keys or misplace our mobile phone, even forget to pay the odd bill on time, anything that is starting to impact the health and wellbeing of the person is an indicator that something is not right and needs to be investigated.

Untidy home or change in habits

What about if the person is not displaying signs of forgetfulness? Still, you find the home is becoming more untidy, dishes have been left unwashed, the fridge contains out-of-date food, the letterbox is full, and the garden is becoming a jungle.

These physical indicators can be a sign that the person is experiencing either physical difficulty in completing tasks, or has become demotivated. It’s an indication that their service plan needs to be reassessed.

Difficulty in moving around

Approximately 50% of older adults report experiencing regular pain in the hip and knee joints, which is generally caused by osteoarthritis. Constant pain impacts the ability and desire of a person to move around, which in turn can lead to a deterioration in their health.

If you see the person sitting down more, maybe having difficulty in getting up from their chair, being slower in answering the door or choosing to go out into the community less, take note.

These symptoms can also mean the person becomes at higher risk of falls.

Other physical changes and indicators

A loss of appetite often results in the person losing weight, as can problems with the mouth and teeth or swallowing difficulty. Sometimes it's also simply that the person is becoming tired more easily and finds eating exhausting.

Any loss of weight is also an indicator that something needs to be investigated.

If you find the TV or radio appears to be turned up loud, they might be experiencing increasing hearing loss.

Perhaps you notice the person's car has a number of scratches and dents that weren't there before – they may be experiencing a loss of vision, a change to their depth perception, or they may be experiencing physical changes that impact their ability to move their neck and shoulders which means they are not seeing hazards.

What about bruising, cuts or burns? Dizzy spells or increased frailty can result in unexplained lesions. Additionally, if the person appears to be experiencing more frequent or serious illnesses this can indicate physical deterioration.

Personal care staff should be alert to any unexplained skin tears or bruising they notice when helping a client. And attention to the person's overall physical appearance should be something that all care staff can note, whether the person lives at home, visits day respite regularly or lives in a residential facility.

What should your response be?

While some of these changes may initially present as something that is of minor importance, even if there are no serious concerns about how these are impacting the person, you should note the issue in their progress notes.

Even if it's just that you know “something” has changed but you're not sure what, note it down, and report it to your care manager so that they can speak to the person or their carer.

Well-written observations can help to pinpoint a problem which assists care planners as they work with the person and their carer to address the issue in a timely manner, so make sure you write up your progress notes regularly.

And if you're looking to learn how to write up progress notes we have a short online course that will help you to upskill in this area.

Often the deterioration or change is something minor, something that can be addressed easily and quickly, but sometimes it's more. If you're able to identify this change or deterioration in the early stages, and if appropriate and timely action is taken to address the issue the outcome for the long-term overall health and wellbeing of the person is more likely to be positive.

If you can think of someone else who might benefit from this article, send them a link. We’d appreciate it! And if you’re looking for more helpful resources, why not check out our Total Quality Package resource hub? We have culturally appropriate, tailored resources that are designed to make your job simpler and help you provide quality care to your clients. Click here to find out more.

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