What’s the “Downward Spiral”?

This refers typically to the last year of life for many seniors, when one “health crisis” or problem leads to another problem, with each event causing the senior to become more dependent on others for more care: a “spiraling down at the end of life”.

As a person with chronic diseases ages, they no longer have the physiological resources to cope with changes. It’s been described as someone walking along the edge of a cliff: when a good gust of wind blows them off, they can’t climb back up again. The “gust of wind” can be in the form of an infection, a broken hip, heart attack or stroke. Each event leads to more events with hospitalizations and visits to the doctor.


They start to need increasing assistance with their ADL’s (Activities of Daily Living – bathing, walking, toileting, cooking/eating, dressing). They begin to eat less, start losing weight, talk more often about family members who have already died and how much they miss them; they may want to visit graveyards more; sometimes make specific plans about their affairs/will/funeral; and begin saying how “tired” they are and often how ready they are to just “go on”.


Family members can’t always see these changes at the time (or don’t want to see them). But, with probing questions and hindsight, the “Downward Spiral” becomes obvious.


Families and doctors need watch for the “Spiral”, discuss the goals of care [see separate article], and prepare for this natural transition in life, so we can help the senior to live comfortably and with as much dignity as possible. For, the more we tend to do to them, the more we may only add to or prolong their suffering.