A cascade of complications in a hospitalized frail older patient: is a better management possible?

Methods. Describing the complications that an older patient underwent during his hospital stay.Results. An 87-year-old man was admitted to the San Raffaele Hospital for a transient loss of consciousness (LOC). He was hospitalized for assessing the causes of the LOC. The LOC lasted 2 minutes, was associated with bilateral upper limb clonus and subsequent confusion. The patient was severely comorbid: he suffered from metabolic syndrome, chronic kidney failure, hemodynamically significant carotid atheromasia, anemia, and he had a dubious history of epilepsy. Moreover, the patient was cognitively impaired and many episodes of LOC were reported in his medical history. During the hospital stay the patient developed many complications: a fall, nosocomial pneumonia, urinary retention and deconditioning.Conclusions. Global aging poses several challenges to society and public health systems. The traditional models of care are not suitable to face the complex needs of frail older people for whom standard decisional algorithms are seldom applicable. The context of hospitalization, though necessary, may be hazardous risky for the health of older people, especially the frailer ones.