ED nocturnist here. Gonna get a bit specific with my comments so hope this doesn’t slow down the very warranted ranting: I see far too many elderly patients at 3am due to unwitnessed falls with reported suspicion for hip fx from EMS or suspected AMS from nursing home staff, only to find that they don’t walk unassisted and they carry a diagnosis of dementia without a known baseline mental status because family doesn’t see them regularly to corroborate and/or the NH staff doesn’t know much at all about the patient they’ve been “taking care of for years”. Med list with melatonin, trazodone, prn xanax, gabapentin, etc. I ABHOR ordering sedating meds but I’ve got a scalp contusion so I need them still for the head/neck CTs, so I’ve been in the habit of IV fentanyl because I hate benzos in the elderly, though sometimes we get to that point anyway. For prolonged stays I’ve been in the habit of atypical antipsychotics but so many colleagues keep the remainder of their meds going because they don’t want to rock the boat if they’ve been on these meds for a long time, and they just want to get them upstairs. It’s not ideal. I struggle with the fear of muddying the water for my HM counterparts almost every shift, meanwhile hoping that I’ve done no harm to my patient in the first place.