Nearly half a million elderly people are treated in hospital every year because of injuries sustained during a fall, not all of whom will be as fortunate as Baroness Thatcher who is reported to be doing well after surgery on her fractured left arm. For many older people a fall and a broken bone will be the beginning of a cascade of events that leads to their eventual demise — one in five of those admitted to hospital with a broken hip are dead within three months.

There is a complex relationship between falls, fractures, hospital treatment and the rapid deterioration of an older person who appeared outwardly healthy before his or her accident. The fall itself may be an indication of an underlying problem, ranging from general infirmity to serious heart problems. The fracture is often a sign of osteoporosis, where increased fragility of the bones means they snap or crumble after relatively minor trauma. And then there are the dangers of being laid up in a hospital bed — the elderly and hospitals don’t mix and they are particularly prone to complications such as hospital-acquired infections.

But although relatives often worry about superbugs such as MRSA and Clostridium difficile, the real threat to the wellbeing of their loved ones often comes from less familiar quarters. Immobility leads to rapid physical deterioration, a problem often compounded by poor nutrition, and as many as one in twenty patients who have had surgery for a fractured hip will die from a blood clot — a largely preventable condition.

During my formative years in hospital I will never forget the change in the wards as I moved from paediatrics to elderly care. As a paediatrician I worked on a unit where every patient was almost constantly attended by a parent looking out for his or her son or daughter’s best interests. When I moved to elderly care the wards were largely deserted and the patients left to fend for themselves — something that few of them were fully capable of.

Research shows that elderly patients and their carers, are the least satisfied when it comes to the standard of care they receive from the NHS — and they often have good reason to be concerned. There have been major advances in recent years to ensure that the elderly are treated with respect and that their needs , both clinical and personal, are dealt with in exactly the same way as any other inpatient. But, young children aside, they remain the most vulnerable group in hospital and without input from their family they don’t always receive the care they deserve.

It is a much-abused cliché in the NHS, but the squeaky wheel gets the most oil. Older people need advocates in hospital to question the doctors and nurses about their care, to complain if the ward is dirty and to make sure they eat and drink properly. You don’t have to be rude and aggressive — the staff are on your side — being polite, curious and assertive works much better.

Being there isn’t always easy. Employers are often less willing to give time off to someone keen to look after their mother, than they would a parent with a sick child. Visiting times in many elderly care units are more restricted than the open access on a paediatric ward. But hurdles such as these are not insurmountable.

Make sure you talk to the consultant or one of the doctors looking after your relative as soon as possible after his or her admission to hospital to discuss the treatment. The ward sister should be able to arrange this for you.

Don’t be scared to ask about the hospital policy for preventing complications such as blood clots.

Offer to help at mealtimes and with personal care.

Watch everyone like a hawk — while C.difficile can be caught from dirty wards, MRSA is normally spread through poor personal hygiene. Don’t let anyone touch your relative without washing his or her hands first. And complain if the ward is dirty.

Do whatever you can to ensure an early discharge, even if it means having your relative to stay with you for a while. Thousands of elderly people languish in hospital beds every week because they are not quite well enough to cope on their own at home and they are waiting for social care to be put in place or a temporary residential bed. And the longer you are in hospitals the greater the risk of complications such as bed sores and clots.

Check that your relative has been referred to the falls team — even if the injuries are comparatively minor (an uncomplicated fracture of the wrist is often the first sign of osteoporosis). Good units now have a multidisciplinary team to evaluate why someone has fallen and take steps to stop it happening again.

Tomorrow is National Falls Awareness Day; visit www.helptheaged.org.uk/fallsday for more information.

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