Abstract
Background:
Falls in frail older adults can cause prolonged hospital stays, raising the risk of further falls, infections, and decline. This case shows how delayed discharge and complex care planning can worsen outcomes in this group.
Case Presentation
An 86-year-old male with Alzheimer’s dementia, chronic kidney disease, and peripheral vascular disease sustained an unwitnessed fall at home while taking medication. He was found to have an avulsion fracture of the right anterior superior iliac spine (ASIS) with soft tissue changes and was managed conservatively under orthopaedics. His three-month admission was complicated by multiple hospital-acquired infections (urinary tract infections, chest infection, COVID-19) and two further falls, resulting in a distal radius fracture. Investigations for suspected malignancy led to several MDT referrals and scans. Due to poor prognosis, the patient was placed on palliative care. Discharge planning was significantly delayed due to administrative barriers including Continuing Healthcare funding and nursing home placement issues. The family had several oncology-related questions, which extended the stay while awaiting specialist input. The patient’s condition deteriorated, and he passed away following a cardiac arrest.
Discussion:
This case highlights how prolonged hospitalisation in frail older patients can lead to further falls, infections and behavioural changes often causing greater harm than the original injury. Complex discharge pathways and interdepartmental communication gaps can increase risks for this vulnerable group.
Impact:
Learning from this case was shared at the Morbidity and Mortality meeting to raise awareness of early, coordinated discharge planning and fall prevention especially in frail patients. A ward-based discharge checklist has been introduced to identify and address discharge barriers, highlight them to the managers and improve communication between involved teams.
Conclusion:
Safe, timely discharge for frail patients with minor injuries can prevent avoidable harm. Improved teamwork and structured discharge processes minimize risks linked to prolonged hospital stays following falls.
Comments
Patient journey
Hello. Thank you for letting us know about this patient's journey and the unfortunate ending. How much involvement was there from the local orthogeriatric team? What discussions (if any) were had with patient or the power of attorney / next of kin for this gentleman about appropriateness of investigating for a potential malignancy, especially with his medical history?
Thankyou for asking this…
Thankyou for asking this question. The patient was admitted under Orthopaedics, there wasn't a routine follow up by the geriatrics team. They reviewed the patient once post a referral for behavioral changes including aggression. As the patient was being seen by the mental health team as well- there wasn't much involvement there. The patient had capacity and his family was updated about all the relevant investigations. However, he was put on palliative care post a prognosis of a few short months following a diagnosis of metastasis of unknown origin-when investigations were withdrawn with the agreement of the patient and his family.
Thank you for your poster,…
Thank you for your poster, how much involvement was had from the wider MDT such as therapy and social care during admission to support appropriate intervention in hospital and discharge planning?
Thankyou for this question…
Thankyou for this question. The patient was being seen on an everyday basis by physiotherapy given his history of multiple falls. He was also assessed by social care for his discharge pathway and was put on the CHC pathway post discharge with involvement from transfer of care and allotment to a nursing home.