When acute care is not enough: Care planning as an overlooked dimension of hospitalization in a frail older patient
Authors:
Dominik Vido
Authors‘ workplace:
Léčebna dlouhodobě nemocných, Nemocnice Milosrdných bratří Brno
Published in:
Geriatrie a Gerontologie 2026, 15, č. 2: 90-94
doi:
https://doi.org/10.61568/geri/50-6739/20260506/143570
Overview
Population ageing has led to an increasing number of very old and frail patients admitted to acute care wards. In this patient group, medical management often focuses on treating isolated somatic conditions according to current standards, while functional reserve, prognosis and patient preferences are insufficiently addressed. The absence of early frailty screening and structured care planning may result in fragmented treatment, escalation of unwanted or non-beneficial interventions, and prolonged hospitalisation without meaningful clinical benefit.
We present a case report of a 95-year-old woman admitted after a fall with a proximal femoral fracture. During her acute hospital stay, multiple complications occurred and were managed sequentially and in isolation, without clearly defined goals of care. Although individual interventions were medically justified, their cumulative effect did not correspond to the patient’s functional prognosis or, later, to her explicitly expressed wishes. Re-evaluation of treatment goals and establishment of a ceiling of care were achieved only after transfer to a long-term care facility.
In the discussion, we highlight the importance of early comprehensive geriatric assessment, advance care planning and case management in the setting of acute medical wards. The paper also compares the extent of diagnostic and therapeutic interventions provided in acute versus long-term care, illustrating not only differing care objectives but also the economic implications of delayed care planning. This case underlines that care planning should not be regarded solely as a domain of palliative medicine, but as an essential component of high-quality and sustainable care for frail older adults.
Keywords:
acute care – frailty – case report – case management – care planning – futile treatment – palliative approach
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Labels
Geriatrics General practitioner for adults Orthopaedic prostheticsArticle was published in
Geriatrics and Gerontology
2026 Issue 2
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