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Ceiling-of-care discussion in frailty — SCE Acute Medicine MCQ

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ModeratePerioperative Medicine, End-of-Life Care and Patient SafetyCeiling-of-care discussion in frailtySCE Acute Medicine

A 89-year-old woman is assessed on the acute medical unit. She has advanced frailty, recurrent aspiration pneumonia and lacks a clear escalation plan. She is now septic but still able to express preferences. Initial assessment includes relevant observations, bedside tests and urgent blood results. What would you advise this patient?

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Correct answer: A — Discuss escalation preferences and document capacity and best interests

Discuss escalation preferences and document capacity and best interests is the best answer because acute deterioration in frailty requires timely shared decision-making and documentation of escalation decisions. Advise strict sick-day rules and urgent review if vomiting persists is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Ceilings of care should guide treatment rather than deny good acute care.

Reference: https://www.nice.org.uk/guidance#acute-medicine-order-44-1