An 87-year-old with dementia is admitted after two falls and confusion. CFS 7, lives alone, normally walks with a frame. Manage the admission.

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Accepted Answer

Frail elderly admission — I'd take a comprehensive geriatric assessment approach. Confirm delirium with the 4AT, obtain a collateral history about baseline function and triggers, and screen for reversibles using PINCH ME: pain, infection, nutrition, constipation, hydration, medications, environment. I'd review every drug for anticholinergic burden using STOPP/START. For the falls I'd check lying-and-standing BP, ECG for arrhythmia, vision, footwear, vitamin D and bone profile, calculate FRAX and arrange DEXA. Non-pharmacological delirium management first — orientation, hydration, family presence, sleep hygiene — reserving low-dose haloperidol only for distress harmful to self/others, and never in Lewy body or Parkinson's. The MDT — PT, OT, SALT, pharmacy, social work — would be involved from day one. I'd hold a family meeting to discuss goals of care, ceiling of treatment and a realistic discharge plan, considering frailty virtual ward or Hospital at Home to avoid deconditioning.

Acute delirium with falls in frailty

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