Dorothy Hayes

Dorothy Hayes was seventy-nine and had lived alone since her husband's death three years earlier, managing her household with the stubborn independence that her children both admired and worried about. When her neighbour received no answer at the door and found Dorothy on her kitchen floor — she had fallen reaching for the kettle the previous evening — the scene was frightening. A fractured hip was confirmed in the emergency department. Dorothy was frightened and in pain, and she was also profoundly embarrassed. 'I felt like I had failed somehow,' she says. 'That I had let my age catch up with me.' What she encountered at Silvaris Rehabilitation Center in Portland changed that feeling completely.

The orthopaedic and orthogeriatric teams worked in tandem from the moment of her admission. The fracture required surgery within twenty-four hours to reduce the risks of prolonged bed rest, and Dorothy was taken to the operating theatre the following morning. The operation went smoothly. More importantly, a comprehensive geriatric assessment — conducted by the orthogeriatric consultant who reviewed all orthopaedic ward patients — identified several factors that had contributed to Dorothy's fall and would need to be addressed to reduce the risk of future ones: osteoporosis that had never been formally treated, a medication regimen that included a drug known to increase fall risk, and some early memory changes that merited monitoring. 'He looked at the whole picture,' Dorothy says. 'Not just the hip.'

Mobilisation began on the day after surgery. The physiotherapy team coaxed Dorothy gently but firmly out of bed and onto her feet — an experience she describes as terrifying and empowering in equal measure. 'I was convinced I would fall again,' she says. 'The physiotherapist held my arm and told me that she would not let that happen, and somehow I believed her.' Progress was incremental but consistent: a frame first, then a stick, then short walks without assistance. An occupational therapist assessed her home before discharge and arranged for a series of adaptations — grab rails, a higher toilet seat, a bath board, removal of the loose rugs that had contributed to her fall.

The osteoporosis management was initiated before her discharge: a bisphosphonate prescription, vitamin D and calcium supplementation, and a dexa scan referral to quantify her bone density. The medication that increased fall risk was deprescribed and an alternative found. A falls assessment clinic follow-up was arranged for six weeks post-discharge, where she completed a structured balance and strength programme. Her GP was written to with a detailed summary and clear requests for ongoing monitoring of her bone health and medications. The transition from hospital care to community follow-up was meticulously coordinated, something Dorothy's daughter, who had accompanied her throughout, describes as 'seamless and reassuring.'

Six months after her fall, Dorothy is walking with a stick for outdoor distances but independently at home without aids. She attends a weekly strength and balance class at her local community centre, a referral that came via the falls service. Her bone density scan confirmed osteoporosis and her medication is protecting against further bone loss. She has not fallen since. She lives independently, cooks her own meals, and sees her children and grandchildren weekly. 'I thought that fall might be the end of my independent life,' Dorothy says. 'The team at Silvaris made sure it was not. They fixed my hip, but more than that, they fixed the reasons it had broken.'