DECLINE IN
HEALTH STATUS
Progression of
disease as documented by symptoms, signs, and test results.
Decline in
Karnofsky Performance Status or Palliative Performance Score/Adapted Karnofsky.
Weight loss. This may be assessed in the way(s) felt to be most sensitive to the patient’s condition and wishes, yet gives the most conclusive evidence. Weight on scales is the most objective. Other methods include decreasing anthropometric measurements (mid arm circumference, abdominal girth), decreasing serum albumin or cholesterol; observations of ill fitting clothes, decrease in skin turgor, increasing skin folds, and other observations as may apply in a given case. Some specific observation about weight loss must be made.
Dependence on
assistance for two or more activities of daily living (ADLs):
Feeding
Ambulation
Continence
Transfer
Bathing
Dressing
Dysphagia
leading to inadequate nutritional intake (document by, for example, a trend
established by comparing changes in food portion consumption) or recurrent
aspiration.
Decline in
systolic blood pressure relative to the patient’s baseline reading or
progressive postural hypotension.
Evidence of the
increasing need for skilled service.
Decline in
Functional Assessment Staging (FAST) for dementia.
Progressive
stage 3-4 pressure ulcers in spite of optimal care.
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