Coronial
TASaged care

Coroner's Finding: Martin, Shirley Dorothy

Deceased

Shirley Dorothy Dawn Martin

Demographics

91y, female

Date of death

2022-08-24

Finding date

2024-12-18

Cause of death

exacerbation of behavioural and psychological symptoms of dementia following surgical repair of hip fracture

AI-generated summary

Shirley Dorothy Dawn Martin, an 91-year-old with advanced Alzheimer's disease and multiple comorbidities, sustained a hip fracture from an unwitnessed fall at an aged care facility on 8 August 2022. She underwent surgical repair on 9 August 2022 but post-operatively remained confused, agitated, and refused medications. She was discharged back to aged care on 19 August 2022 where her behavioural and psychological symptoms of dementia exacerbated significantly. She deteriorated rapidly and died five days later. The coroner found the RACF's falls prevention strategies, post-fall care, and response were appropriate and adequate. A 3-hour 47-minute ambulance delay was attributed to appropriate triage categorisation, regional surge conditions, and staffing shortages. The death was not preventable.

AI-generated summary and tagging — may contain inaccuracies; refer to original finding for legal purposes. Report an inaccuracy.

Specialties

geriatric medicineorthopaedic surgeryemergency medicineparamedicine

Clinical conditions

Alzheimer's diseasedementiahip fracturedeliriumtype II diabetesacute myocardial infarction historycongestive cardiac failurechronic renal failureosteoporosisparoxysmal atrial fibrillation

Procedures

open reduction and internal fixation of left hip fractureblood transfusion

Contributing factors

  • advanced Alzheimer's disease with progressive cognitive decline
  • confusion and agitation in the weeks preceding the fall
  • unwitnessed fall at aged care facility
  • post-operative delirium and behavioural disturbance
  • refusal of medications post-operatively
  • minimal pain management in immediate post-operative period
  • rapid deterioration following return to aged care
Full text

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