Deterioration
The deteriorating resident
Acute illness in an older resident rarely announces itself. This section is written mainly for registered nurses, care staff and facility leadership. It covers the early signs of deterioration, delirium, urine tests and antibiotics, chest infection, sepsis, dehydration, how to escalate concern, and how decisions about hospital are made.
By Dr Josh Hatch, FRACGP
Where to start
Residents & families
Aged care staff
GPs & clinicians
All topics
Recognising deterioration in a resident
The early signs are often subtle, fever is often absent, and the people who know the resident best usually notice first
Delirium: recognising it and finding the cause
A sudden change in attention and thinking, often quiet, usually with a cause that can be looked for
Urine tests, “UTIs” and asymptomatic bacteriuria
Why a positive dipstick so often misleads, and what makes a urinary infection more or less likely
Antibiotics and antimicrobial stewardship in aged care
What the national survey shows, what the aged care guidance asks for, and what stewardship trials have achieved
Chest infections and aspiration
How pneumonia shows itself in residents, aspiration and mouth care, and treating in the facility
Sepsis in older people
Why sepsis is easy to miss in a resident, the question to ask, and how goals of care shape the response
Dehydration and acute kidney injury
Why the bedside signs of dehydration are unreliable, and what is known about pausing medicines during illness
Escalating concern: the GP, after-hours care and 000
How to make a call that gets the right response, who to call, and when an ambulance is the answer
Hospital or not: goals of care and hospital avoidance
What happens to residents who go to hospital, what treating in place has achieved, and the services that support it
The deteriorating resident: a guide for facility leadership
What the Standards require on deterioration and infection, the quality indicator, and questions for governance
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How the evidence is graded
Where interventions are compared, they are graded on randomised trial evidence for the outcome that matters: recovery, harm, hospital transfer, deaths, or antibiotics avoided without harm. Many of the trials were done in North American or European nursing homes rather than in Australian residential aged care, and that is labelled where it applies. Observational and non-randomised evidence is described and labelled but not graded. Australian requirements come from the Quality Standards, the Australian Commission on Safety and Quality in Health Care and government sources, and are dated. This section does not name antibiotics, give doses or set escalation rules; current prescribing guidelines, local advice and each facility’s procedures apply.
- Supported by trial evidence Consistent randomised trial evidence of a benefit that matters.
- Promising, not yet proven A real signal, usually from a single trial, not yet confirmed.
- Uncertain / conflicting Trials conflict, or the evidence is too weak to say.
- Not supported Tested in adequate trials without showing a benefit.
- Risk outweighs benefit Evidence of net harm.
Last full evidence review: November 2026.