Understanding Functional Decline in the Natural Dying Process

Published on September 30, 2023

Updated on December 25, 2023

In this article, we delve into the critical topic of functional decline in individuals nearing the end of life. Understanding these changes is invaluable for hospice nurses, caregivers, and family members as they provide compassionate care during this delicate phase. We will explore various examples of and emphasize the importance of documenting these changes to aid in care provision and decision-making.

Documenting Functional Decline

When a person is nearing the end of life, their physical and mental abilities may decline gradually or rapidly, depending on their illness trajectory. This decline can affect their quality of life, comfort, and care needs. Therefore, it is important for caregivers to keep track of any changes in the patient's functional status, such as their ability to perform activities of daily living (ADLs) like eating, bathing, dressing, and moving around. By keeping a journal of these changes, caregivers can document the patient's condition, communicate with health care providers, and plan for appropriate interventions. The journal should include the following information:

  • Date and Time: Write down the exact date and the approximate time when the change occurred. This will help you monitor the frequency and duration of the changes, and identify any patterns or triggers.
  • Concise Description: Describe the change in a clear and concise way, using specific details and examples. For example, instead of writing “the patient was confused”, write “the patient did not recognize me and asked where he was”. This will help you capture the nature and severity of the change, and provide useful information for diagnosis and treatment.
  • Context: Note what was happening before the change, such as the patient's mood, activity, medication, environment, or any other relevant factors. This will help you understand the possible causes and effects of the change, and adjust the care plan accordingly. For example, if the patient became agitated after a loud noise, you may want to reduce the noise level and provide soothing music or touch.

Examples of Moderate to Major Decline

As a person approaches the end of life, their body and mind may go through various changes that affect their functioning and well-being. These changes can be moderate or major, depending on how much they interfere with the person's normal activities and comfort. Some examples of moderate and major declines are:

Moderate Declines

  • Alzheimer's Progression: Alzheimer's disease is a type of dementia that causes memory loss and cognitive impairment. It has seven stages, from mild to severe. A moderate decline in Alzheimer's is when a person moves from stage 7A to 7B, which means they lose the ability to speak or smile, and need assistance with all basic tasks.
  • Eating Habits: Eating is essential for maintaining health and energy. A moderate decline in eating habits is when a person who used to eat full meals now eats less than half of what they used to. This can be due to loss of appetite, difficulty swallowing, nausea, pain, or depression.
  • Oxygen Requirements: Oxygen is vital for the functioning of the organs and tissues. A moderate decline in oxygen requirements is when a person who could breathe normally now needs supplemental oxygen, either at night or during the day. This can be due to lung disease, heart failure, or low blood pressure.
  • Mobility: Mobility is the ability to move around and perform physical activities. A moderate decline in mobility is when a person who could walk without help now needs a cane or a walker. This can be due to muscle weakness, joint pain, balance problems, or fatigue.
  • Frequent Falls: Falls are a common cause of injury and disability among older adults. A moderate decline in fall frequency is when a person who rarely fell now falls every one or two weeks. This can be due to vision problems, medication side effects, dizziness, or confusion.
  • Dietary Changes: Diet is the type and amount of food that a person eats. A moderate decline in diet is when a person who could eat regular food now needs softer food that is easier to chew and swallow. This can be due to dental problems, dry mouth, or swallowing difficulties.
  • Orientation Shift: Orientation is the awareness of oneself and one's surroundings. A moderate decline in orientation is when a person who was fully oriented to person, place, time, and situation now becomes confused about one of these aspects, usually time. This can be due to dementia, , or medication effects.
  • Complexion Alteration: Complexion is the color and texture of the skin. A moderate decline in complexion is when a person who had a healthy skin tone now becomes pale yellow or shows subtle changes. This can be due to liver problems, anemia, or dehydration.
  • Sleep Patterns: Sleep is the state of rest and recovery for the body and mind. A moderate decline in sleep patterns is when a person who used to sleep eight to twelve hours a day, including naps, now sleeps twelve to sixteen hours a day. This can be due to depression, pain, or reduced activity.

Major Declines

  • Advanced Alzheimer's: A major decline in Alzheimer's is when a person jumps from stage 7A to 7C or later, which means they lose the ability to respond to their environment, control their movements, or recognize their loved ones.
  • Severe Eating Decline: A major decline in eating habits is when a person who used to eat full meals now stops eating altogether. This can be due to severe nausea, pain, or loss of consciousness.
  • Continuous Oxygen: A major decline in oxygen requirements is when a person who needed supplemental oxygen occasionally now needs it continuously. This can be due to respiratory failure, cardiac arrest, or shock.
  • Complete Immobility: A major decline in mobility is when a person who could walk with assistance now becomes completely bedridden. This can be due to paralysis, coma, or severe weakness.
  • Frequent Falls: A major decline in fall frequency is when a person who fell every one or two weeks now falls one or more times a day. This can be due to severe vision problems, medication overdose, seizures, or strokes.
  • Dietary Shift: A major decline in diet is when a person who could eat softer food now needs pureed food that is easier to swallow. This can be due to severe dental problems, mouth sores, or choking risk.
  • Disorientation: A major decline in orientation is when a person who was confused about one aspect of their situation now becomes completely disoriented to person, place, time, and situation. This can be due to advanced dementia, severe , or brain damage.
  • Complexion Changes: A major decline in complexion is when a person who had a pale yellow or subtle skin tone now becomes dusky, gray, yellow, pale, or waxy. This can be due to organ failure, infection, bleeding, or death.
  • Excessive Sleep: A major decline in sleep patterns is when a person who used to sleep twelve to sixteen hours a day now sleeps more than twenty hours a day. This can be due to coma, sedation, or imminent death.

The speed and extent of these declines can vary from person to person, depending on their illness, age, and other factors. However, they can help clinicians estimate how much time is left for the person before they die. They can also help caregivers prepare for the end of life and provide the best possible care and comfort for their loved one.

The Importance of Documentation

Keeping a journal of the patient's is not only a useful tool for caregivers, but also a valuable source of information for health care professionals. By documenting the date and time of each change, caregivers can provide accurate and timely reports to the patient's doctor, nurse, or hospice team. This can help them assess the patient's condition, adjust the treatment plan, and determine the eligibility for or other services. Moreover, by tracking the frequency and magnitude of the changes, caregivers can estimate how fast the patient is approaching the end of life, and prepare themselves emotionally and practically for the final stage.

Conclusion

In summary, comprehending functional decline is pivotal for caregivers providing end-of-life care, particularly within the hospice setting. By diligently documenting moderate to major changes in a patient's condition, caregivers can assist in recertification visits and gain insights into the pace of decline. This article offers comprehensive examples of such declines, ranging from eating habits to mobility and mental status. It is imperative for caregivers to promptly report any moderate or significant changes to healthcare practitioners. Ultimately, monitoring functional decline contributes to better preparation for both patients and their families as they navigate the end-of-life journey.

Resources

The Importance of Caregiver Journaling

Reporting Changes of Condition to Hospice

Breathing Patterns Before End of Life: Critical Clues for the Last Hours!

Trigger Words for Hospice Nurses: Assessing End-of-Life in Two Weeks or Less

Functional decline in old age

Eldercare Locator: a nationwide service that connects older Americans and their caregivers with trustworthy local support resources

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My Aging Parent Needs Help!: 7 Step Guide to Caregiving with No Regrets, More Compassion, and Going from Overwhelmed to Organized [Includes Tips for Caregiver Burnout]

Take Back Your Life: A Caregiver's Guide to Finding Freedom in the Midst of Overwhelm

The Conscious Caregiver: A Mindful Approach to Caring for Your Loved One Without Losing Yourself

Dear Caregiver, It's Your Life Too: 71 Self-Care Tips To Manage Stress, Avoid Burnout And Find Joy Again While Caring For A Loved One

Everything Happens for a Reason: And Other Lies I've Loved

The Art of Dying

Final Gifts: Understanding the Special Awareness, Needs, and Communications of the Dying

Providing Comfort During the Last Days of Life with Barbara Karnes RN (YouTube Video)

Preparing the patient, family, and caregivers for a “Good Death”

Velocity of Changes in Condition as an Indicator of Approaching Death (often helpful to answer how soon? or when?)

The Dying Process and the End of Life

The Last Hours of Life

As an Amazon Associate, I earn from qualifying purchases. The amount generated from these “qualifying purchases” helps to maintain this site.

Gone from My Sight: The Dying Experience

The Eleventh Hour: A Caring Guideline for the Hours to Minutes Before Death

By Your Side , A Guide for Caring for the Dying at Home

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