Recognition and management of acute functional decline in older people living in care homes: a qualitative interview study with UK care home staff

This is the authors' abstract. We don't add key points for this paper.

BACKGROUND: Older people living in care homes who experience acute functional decline pose a diagnostic challenge to GPs. AIM: We aimed to explore beliefs, practices, and experiences of UK care home staff who first recognise and respond to acute functional decline, including in the context of the COVID-19 pandemic. DESIGN & SETTING: Qualitative interview study with 25 UK care home staff. METHOD: Semi-structured interviews were conducted by telephone between January 2021 and April 2022. Thematic analysis was facilitated by NVivo software. RESULTS: and a more significant deviation, particularly for residents with a variable baseline. Acute functional decline caused anxiety to care home staff, in part due to the uncertainty about illness trajectory and outcome. They commonly considered urinary tract infection (UTI) to be a likely underlying cause. Some participants described a watch-and-wait approach or trying simple interventions, while others preferred escalating directly to outside clinical support. Triggers for escalation included perceived severity of illness, gut feeling, or failure to respond to initial supportive management. CONCLUSION: This study has highlighted the complexities around the identification and management of a care home resident experiencing acute functional decline. There was variation in interpretation and responding to these episodes within the care home. More work is needed to understand the physiology and risk profiles of acute functional decline, as well as any relationship to UTI.