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Case 10: Functional Preservation, Delirium Presentation, Interdisciplinary Team Communication in the Context of a Patient Who Presents With a Hip Fracture

Learning Objective
Describe inpatient interdisciplinary team care pathways for older adults
0.5 Credit CME

An 85-year-old woman is admitted to the hospital through the emergency department (ED) after she tripped and fell at home. On arrival in the ED, she reported that she hit her head against the bedroom nightstand but did not lose consciousness. The patient is a widow who lives alone at home and was found on the floor by her neighbor who checks in on her every day. She has one daughter who lives 50 miles away. The patient had previously been active and independent and able to perform activities of daily living and walk around her neighborhood. She has type 2 diabetes mellitus treated with glyburide (5 mg daily) and nonvalvular atrial fibrillation treated with apixaban (5 mg twice daily). On examination in the ED, the patient appears thin and frail. She reports severe spasms and pain in her right hip. There is shortening and external rotation of the right lower extremity.

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Advisory Panel

The following members of the advisory panel had no relevant financial relationships with ineligible companies to disclose:

• Ruben Azocar, MD

• George Drach, MD

• Sandhya Lagoo-Deenadayalan, MD, PhD

• Andrew Lee, MD

• Mike Malone MD

• Myron Miller, MD

• Arvind Nana, MD

• Tom Robinson, MD

• Victoria Tang MD, MAS

The following members of the advisory panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of planning decisions by persons without relevant financial relationships and recusal from any aspect of planning and content related to the financial relationship:

• Kevin Biese MD, MAT is a paid consultant for Call 9 Telemedicine Medical Advisor and Bristol Meyers Squibb/ Pfizer

• Daniel Mendelson, MS, MD is a paid consultant for Point Click Care Touchscreen

Writing Panel

The following members of the writing panel had no relevant financial relationships with ineligible companies to disclose:

• Tomas Griebling, MD

• Joseph Hejkal, MD

• Melissa Hornor, MD

• Jason Johanning, MD

• Sushila Murthy, MD, MPH

• Tony Rosen, MD, MPH

• Kate Schenning, MD, MPH

The following members of the writing panel have reported relevant financial relationships with ineligible companies that have been mitigated through peer review of content by persons without relevant financial relationships:

• Charles Brown, MD is a paid consultant for and receives grants from Medtronic

• Badrinath Konety, MD, MBA is a paid consultant for NxThera, and Bristol Myers Squibb, Opko and receives grant funding from Photocure, Genentech, and Genomic Health

Reviewers:

The following reviewers had no relevant financial relationships with ineligible companies to disclose:

• Shamsuddin Akhtar, MD

• Patrick Kortebein, MD

• Joseph LoCicero, MD

Support Statement

This CME activity is supported by a grant from the John A. Hartford Foundation.

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