pulmonary thromboembolism due to fractured right femur due to a fall
AI-generated summary
Cynthia Thoresen, 88-year-old woman with dementia and osteoporosis, fell at home and sustained a fractured femur approximately three weeks before admission. Her daughter, the registered carer, failed to seek medical attention despite clear evidence of severe pain and immobility. The patient remained bedbound in filthy conditions, developing pressure sores and malnutrition. Hospital staff provided appropriate, multidisciplinary care including prophylactic anticoagulation, but the patient deteriorated and died from pulmonary embolism. Clinical lessons: family carers require oversight through mandatory annual medical reviews; elderly patients with dementia need access to general practitioners; fracture complications demand urgent medical evaluation; and signs of elder neglect must trigger welfare intervention immediately.
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Specialties
orthopaedic surgeryemergency medicinegeriatric medicinepalliative carerespiratory medicinegeneral medicine
tractionattempted fracture reduction under general anaesthesiachest aspirationnasogastric tube insertion
Contributing factors
three-week delay in seeking medical attention after fall
prolonged immobility
fracture healing without surgical fixation
severe malnutrition and dehydration
pressure sores and skin contamination
advanced age and dementia
osteoporosis
lack of general practitioner oversight for 5+ years
inadequate family carer management
fluid overload from intravenous therapy
Coroner's recommendations
A recipient of the carer's benefit should be required to submit an annual independent medical review of the person being cared for to prevent appalling decline in wellbeing of vulnerable elderly persons
The matter should be referred to the Attorney General for consideration of referring the issue of review of legislation to the Queensland Law Reform Commission to create a new offence more akin to offences relating to cruelty to children, to address gaps in existing law for prosecuting elder neglect
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