Here is the standardised PICO analysis for the tenth uploaded article:
Full Title
Emergency Palliative Care: Early Assessment of an Older Adult With a Fall and Hip Fracture
Authors: Maura Kennedy et al.
Journal: Journal of Palliative Medicine, 2024; 27(3): 430–433
Type of Study
Clinical case report with structured commentary and evaluation of integrated geriatric palliative care in the emergency department (ED)
PICO Summary
Population (P)
- Mr. F, a 96-year-old man with multimorbidity (diabetes, coronary artery disease, chronic kidney disease, hypertension, depression)
- Presentation to the ED after a fall with displaced femoral neck fracture, dehydration, hypernatremia, and later delirium
- Context: Urban Level 1 trauma centre, prolonged ED stay (>10 hours)
Intervention (I)
- ED-based integrated geriatric palliative care consultation
- Multidimensional geriatric assessment (aligned with the 4Ms framework)
- Serious illness communication with family
- Delirium diagnosis and non-pharmacological mitigation
- Pain management (multimodal, including non-verbal pain scale, acetaminophen, nerve block, hydromorphone for renal function)
- Medication review (deprescribing inappropriate drugs like zolpidem)
- Discharge planning including social work and primary care follow-up
Comparison (C)
- Implicit comparator: standard ED care without geriatric palliative consultation
- ED environment itself poses barriers to optimal geriatric care (e.g. long boarding times, poor continuity, noisy environment, communication gaps)
Outcomes (O)
Person-centred outcomes:
- Goals-of-care discussion established that independence and avoiding burdensome interventions were most important
- Consent for surgery aligned with personal values
- Code status changed post-operatively to DNR/DNI
Process outcomes:
- Earlier symptom control for pain and delirium
- Enhanced family engagement and streamlined discharge plan
- Initiation of grief counselling and depression follow-up
Health system outcomes:
- Avoidance of inpatient delays for palliative care initiation
- Potential for reduced inpatient length of stay, costs, and complications (supported by references to evidence-based outcomes of ED-initiated palliative care)
Findings Summary
- Geriatric palliative care in the ED can address critical unmet needs—delirium, poor symptom control, fragmented communication—especially in older adults with complex conditions like hip fracture
- The case exemplifies how timely consultation led to better alignment with patient goals, reduced distress, and proactive planning
- Recommends broader implementation of ED-based palliative services, particularly when inpatient delays are expected or orthogeriatric models are unavailable
Life In The Slower Lane 
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