Recognising physical, mental-state and functional change

Deterioration can appear in breathing, circulation, alertness, pain, mobility, toileting, eating and drinking, mood or mental state. Staff should look for a pattern of small changes over time rather than waiting for a single defining sign. Several minor changes together can indicate a serious problem.

Examples include new breathlessness, reduced mobility, sudden weakness, new confusion, reduced urine output, poor intake, temperature change, worsening pain, collapse, a new fall, agitation, unusual drowsiness or a sharp increase in care needs. If the service uses local observation tools and a staff member is trained and authorised to take observations, those measurements can support escalation but do not replace concern about the whole person.

Frontline changes that should raise concern

• Breathing and circulation: new shortness of breath, faster breathing, looking clammy or feeling faint.
• Alertness and thinking: confusion, reduced responsiveness, agitation, hallucinations or new sleepiness.
• Function: unable to stand as usual, suddenly needing more help, slower walking or unexplained weakness.
• Intake and output: poor food or fluid intake, reduced urine, diarrhoea, vomiting or constipation.
• Comfort and behaviour: grimacing, guarding, refusing care, sudden distress or unusual withdrawal.

Deterioration is often easiest to recognise when staff join the physical, mental and functional changes into one clear story.