Common causes of deterioration in care homes

Deterioration in care homes usually has a practical cause, often more than one. Common contributors include infection, dehydration, delirium, constipation, pain, injury, urine retention, poor oral intake, medicine side effects and recent hospital discharge or treatment changes. In people with frailty, a relatively small problem can cause a large change in function or alertness.

For safe escalation, report the full picture rather than attempting to name a single diagnosis. Details such as new confusion combined with constipation, reduced intake and a recent medicine change give a clinician far more to act on than a note that a resident is "not right."

Causes and clues that often travel together

• Infection: fever, cough, shivering, a change in urine pattern, reduced intake or acute confusion can occur together.
• Dehydration: dark urine, dizziness, dry mouth, constipation, weakness and confusion often coexist.
• Delirium: a sudden change in mental state that may be triggered by illness, pain, dehydration or medicines.
• Pain or injury: falls, guarding, refusal to move or distress during care are important clues.
• Medicines and discharge change: new drugs, dose adjustments or missed doses can affect alertness, blood pressure, bowel function or mobility.

Good escalation does not depend on being certain of the cause, but it does depend on spotting likely contributors and handing them over clearly.