Transition to end-of-life in the aged care setting: Identifying the changes

This paper will present the phase one findings from a research project investigating changes associated with a residents' transition to end-of-life in residential aged care facilities (RACF).

The research purpose was to learn from RACF aged care nurses what changes they recognised that indicated a resident had entered the terminal phase of care. This is a challenging aspect of nursing practice because the changes in the resident's condition are frequently subtle and sometimes difficult to identify due to their slow deterioration. In order for the best end-of-life care to be given to residents, timely and accurate assessment of this phase would enable the best possible and most appropriate care to be commenced.

Phase one of this research project was undertaken using an ethnographic approach employing semi-structured interviews. The findings from phase one were used to construct a Delphi survey, which is currently in progress.

The phase one findings were that there are two distinct phases that occur sequentially when a resident is close to end-of-life. The pre-terminal phase occurs around two weeks before the second or terminal phase which occurs around one to three days prior to death. In each of these phases there are distinct changes that present in relation to the resident's physical status and their engagement with their surroundings. These changes will be described. Several of these changes were regarded as clusters and it was felt that for them to be used reliably as indicators of transition to the end-of-life phase, it was necessary for all to be present.