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Discharge planning after resolved delirium — SCE Geriatric Medicine MCQ

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HardTransfer of careDischarge planning after resolved deliriumSCE Geriatric Medicine

An 88-year-old with persistent atrial fibrillation and previous TIA has fallen three times without major injury. ORBIT bleeding risk is high because of uncontrolled hypertension, anaemia and regular ibuprofen. What is the best stroke-prevention response?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Modify bleeding risks and discuss anticoagulation despite age and falls

Explanation lettering: E = shown as A · C = shown as B · A = shown as C · B = shown as E

D is correct: NICE says not to withhold anticoagulation solely because of age or falls risk. ORBIT supports discussion and identifies modifiable hazards; it is not a prohibition threshold. Here hypertension, anaemia and NSAID exposure require active correction while stroke and bleeding trade-offs are discussed. Her previous TIA confers high embolic risk. Aspirin monotherapy is not an alternative for AF stroke prevention, and describing haemorrhage as inevitable misrepresents the evidence.

Reference: NICE NG196: Atrial fibrillation: https://www.nice.org.uk/guidance/NG196/chapter/recommendations