The literal fall of Senator Mitch McConnell.

Hospitalizations after falls in the elderly are common and have scary prognostic implications. But isolated concussions don't usually require multiple-night stays.

Senator Mitch McConnell was hospitalized yesterday after a fall. According to McConnell’s press team, “Leader McConnell tripped at a dinner event Wednesday evening and has been admitted to the hospital and is being treated for a concussion. He is expected to remain in the hospital for a few days of observation and treatment.”

A few comments.

• Falls in geriatric patients are common.

• Falls requiring hospitalization among geriatric patients are common.

• Usually, falls requiring hospitalization for more than one night reflect specific injuries, like broken bones or internal bleeding, or chronic illnesses requiring supportive care or placement into acute rehabilitation facilities.

• Hospitalizations (for more than a night) for a concussion alone are not common in geriatric patients. Generally, a patient who falls and has a concussion might be kept in observation for a night to make sure nothing develops and so that a physical therapy evaluation can be done in the morning to establish the patient will be safe at home. But as I tweeted yesterday, there’s no specific hospital-based treatment for an isolated concussion. So, McConnell’s team saying they anticipate “a few days of observation and treatment” just does not compute with a straightforward concussion. This means that either the Senator experienced more severe injuries than is being acknowledged (or has other chronic illnesses which we are not aware of) or that he is receiving very expensive observation due to his VIP status. (“VIP Medicine”—or VIP Syndrome—is a well-established phenomenon in which celebrity or wealthy patients get more care than is warranted, on the misguided notion that more is always better; it ain’t.)

Jeremy Faust MD MS (ER physician) @jeremyfaust

"He is expected to remain in the hospital for a few days of observation and treatment" for a concussion. What hospital treatments are there for concussions? Either there's more or he's getting "VIP medicine"--i.e. special and $ attention without benefit.

cnn.comMcConnell treated for concussion after suffering fall at DC hotel | CNN PoliticsSenate Minority Leader Mitch McConnell is being treated for a concussion and is staying at a hospital for observation after a fall at a hotel in Washington, DC, on Wednesday evening.

Geriatric falls requiring hospitalization are bad news. As I wrote in Slate a few years ago, most people don’t realize the prognostic implications. As I said back then (when writing about Leonard Cohen):

The one-year mortality for patients who are admitted to the hospital after a fall is a staggering 33 percent. A fall bad enough to warrant hospital admission can carry as poor a prognosis as some stage IV cancers that have metastasized to the lungs and brain.

In addition, based on previous reports, the Senator appears to carry some kind of risk for internal bleeding. Hopefully he has not experienced that now.

Here’s a CDC resource on falls among older people. Everyone who cares about an older person should read this document. It has life-saving and misery-sparing information.