Early social work consultation reduces inappropriate admissions
Isaia et al. European Journal of Internal Medicine 2021
Discharge planning reduces 30-day readmission
Comprehensive discharge planning and 28-day follow-up: Naylor et al. JAMA 1999
Vitamin D supplementation: 800 to 1000 IU/day reduces falls and fractures
Class I recommendation in vitamin D-deficient elderly (AGS)
Depression treatment: SSRIs effective and safe with careful monitoring
QTc monitoring for escitalopram >20 mg/day (>10 mg in elderly)
Patient Discharge Instructions
copy discharge instructions
Discharge instructions for Failure to Cope (Social)
What happened today
You came to the emergency department because you or your family were having difficulty managing at home
We checked for medical causes of your difficulties and treated what we found
We have arranged support services to help you at home
Medications
Take all medications exactly as prescribed
Do not stop any medications without calling your doctor first
If a medication makes you feel dizzy, drowsy, or causes a fall, call your doctor
Bring all medications in their original bottles to your next appointment
Nutrition
Try to eat three meals per day even if your appetite is low
Drink at least 6 to 8 cups of fluid daily unless your doctor has restricted fluids
Use nutritional supplement drinks (such as Ensure or Boost) if meals are difficult
If you cannot eat or drink for more than 24 hours, return to the emergency department
Fall prevention at home
Remove loose rugs, cords, and clutter from walking areas
Install grab bars in the bathroom near the toilet and in the shower
Improve lighting in hallways, stairways, and bathrooms
Use your walker or cane at all times when walking
Wear non-slip footwear indoors and outdoors
Follow-up appointments
See your family doctor within 1 to 2 weeks
Home health nurse or therapist will visit within 48 hours of discharge if ordered
Geriatrics referral has been arranged if applicable
Return to the emergency department immediately if you experience
New confusion, increased disorientation, or unusual behaviour
Fever (temperature > 38 degrees Celsius) or chills
Falls or inability to get up from a fall
Inability to eat or drink
Chest pain, shortness of breath, or new weakness
Feeling so sad that you are thinking about harming yourself
Medication side effects: dizziness, excessive sedation, rapid heartbeat
Caregiver instructions
Caregiver burnout is real; contact your doctor if caregiving feels overwhelming
Respite care options are available through your local Area Agency on Aging
Call 211 (in Canada/USA) for social services and community resources
Keep a medication list and bring it to every appointment
References
Guidelines and key sources
Primary evidence sources
Tsui C, Kim K, Spencer M. The Diagnosis "Failure to Thrive" and Its Impact on the Care of Hospitalized Older Adults. BMC Geriatrics. 2020
88% of failure to thrive admissions have acute medical diagnosis at discharge
Smulowitz PB et al. Association of Functional Status, Cognition, Social Support, and Geriatric Syndrome With Admission From the ED. JAMA Internal Medicine. 2023
Quantifies functional, cognitive, and social admission predictors
Kim DH, Rockwood K. Frailty in Older Adults. New England Journal of Medicine. 2024
Deardorff WJ, Burke RE, Makam AN. Navigating Postacute Care Options After Hospital Discharge. JAMA Internal Medicine. 2026
SNF, home health, PACE options and criteria
Geriatric Emergency Department Guidelines. Annals of Emergency Medicine. 2014
ACEP and AGS joint guidelines for geriatric ED care
Robertson RG, Montagnini M. Geriatric Failure to Thrive. American Family Physician. 2004
MNA-SF, clinical domains, treatment approach
Sarkisian CA, Lachs MS. Failure to Thrive in Older Adults. Annals of Internal Medicine. 1996
Foundational framework for geriatric failure to thrive
DeLiema M et al. The Forensic Lens: Bringing Elder Neglect Into Focus in the ED. Annals of Emergency Medicine. 2016
Elder neglect identification and reporting in ED
ICD-10 coding: R62.7 Adult failure to thrive; Z60.2 Living alone; Z59.41 Food insecurity
CMS ICD-10 coding reference 2024
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.