• assessment
• clinical management
• emergency care systems, admission avoidance
• emergency care systems, emergency departments
• advanced practitioner

Mrs MacDonaldⁱ was 87 years old and had lived on her own since her husband of 60 years died. She had lived in the same house all her married life and although she had three grown-up children, she did not see them regularly as they lived some distance away. She was not able to leave her house very often and over the last few years she had become increasingly frightened that she would fall outside, especially if the weather was bad and the pavements icy.

Mrs MacDonald had been found lying on the floor that morning by her carer, who came to her home every day to assist her with showering, getting dressed and preparing breakfast. It appeared Mrs MacDonald had fallen during the night, and had been on the floor for some hours. Her carer was unable to help her from the floor, and she was complaining of extreme pain in her shoulder. The carer called 999 for the Ambulance Service, and after assessment by paramedics, she was conveyed to the ED of her local hospital.

Mrs MacDonald was seen within the hour by an ED doctor who noted her history of high BP and diabetes. The doctor suspected, from the pain and swelling, that she had a fracture to her humerus; an X-ray confirmed this. As Mrs MacDonald lived on her own, had been to the ED three times already that year as a consequence of falling and was now unable to use her dominant hand, the doctor deemed an occupational therapy assessment necessary. She was concerned about Mrs MacDonald’s ability to care for herself, and indeed, due to the pain she was currently suffering, doubted whether she could even go home at all. She …