An unintentional fall is an event that results in a person inadvertently coming to rest on the ground or at a lower level from causes other than sustaining a violent blow, loss of consciousness or sudden onset of paralysis as may occur during a stroke or epileptic seizure. (1) A long lie is defined as an inability to get up from a fallen position, usually on the floor or ground, for more than an hour. It is associated with complications such as rhabdomyolysis, fear of falling, pneumonia, pressure sores and dehydration. (2) Long lie is a marker of weakness, illness and isolation, and is associated with higher mortality rates. (3) Only 50% of fallers are able to get up from the ground or floor after a fall. (4)

INTRODUCTIONThis study explored and compared the differences in attitudes toward end-of-life care among patients, relatives and healthcare professionals, including doctors and nurses. METHODSWe performed a descriptive study on a cross-section of the population of a tertiary hospital in Singapore.Data was collected using a questionnaire survey involving 50 participants from each of the four groups of patients, relatives, doctors and nurses.RESULTS Family members were the most commonly nominated surrogate decision-makers by the patient group (76%) and the majority of the relative group (74%) felt comfortable deciding on end-of-life care for their loved ones. However, the patient and relative groups differed signifi cantly in their preferences on end-of-life care options, including cardiopulmonary resuscitation (CPR) (p = 0.001), intubation (p = 0.003), nasogastric tube feeding (p < 0.001) and the use of antibiotics (p = 0.023). Doctors, nurses and relatives demonstrated differences in preference between end-of-life care for themselves and for their loved ones, especially with regard to the use of nasogastric tube feeding. There was also a difference between patients and doctors in their decisions on CPR (p < 0.001) and intubation (p = 0.008).CONCLUSION This study demonstrated the importance of early planning for end-of-life care. This must be initiated proactively by healthcare professionals to engage patients in a culturally sensitive manner to discuss their preferences, in order to facilitate open communication between the patient and family.

We report a case of a 70-year-old man who presented with concomitant hip fracture and stroke. Our patient underwent surgical correction of a hip fracture despite the increased perioperative and postoperative risks associated with an acute stroke. He achieved good functional outcome after surgery and subsequent rehabilitation. There are no clear guidelines on the factors to determine whether a patient with concomitant stroke and hip fracture is a good candidate for surgical hip repair. Furthermore, there is also no consensus on the appropriate timing of surgical repair for such patients. We postulate that factors such as functional status, comorbidities, type and severity of stroke will affect the decision to proceed with surgical repair, and that there is a benefit in advocating for surgery in appropriate patients by a multidisciplinary orthogeriatric care team.