Can an 86‑year‑old male who recently fell and was evaluated with X‑ray, discharged from the emergency department, be cleared for air travel this week?

Fitness to Fly After Recent Fall in an 86-Year-Old Male

This patient should NOT be cleared for air travel this week without critical additional information about his X-ray findings, current functional status, and medical stability following his recent fall and emergency department evaluation.

Essential Missing Information That Determines Flight Clearance

The question lacks the most critical piece of information needed to make this determination: what did the X-ray show? The decision hinges entirely on whether the patient has:

• A fracture (particularly hip, pelvis, or vertebral compression fracture) 1
• No fracture but significant soft tissue injury
• Completely normal imaging

Additionally, you must know:

• Time elapsed since the fall (patients recently hospitalized are at increased risk for acute mental distress and delirium during travel) 1
• Current functional status (can he pass a "Get Up and Go" test?) 2
• Reason for the fall (syncope, orthostatic hypotension, cardiac arrhythmia, or mechanical trip?) 2

Decision Algorithm Based on X-Ray Findings

If X-Ray Shows a Fracture

Do NOT clear for flight. Hip fractures and other significant fractures in elderly patients require:

• Urgent orthopedic evaluation and likely surgical intervention within 24-48 hours 1
• Immobilization and pain control
• VTE prophylaxis 1
• The patient is at high risk for complications including delirium, DVT/PE, and further injury during travel 1, 2

If X-Ray is Normal But Patient Has Concerning Symptoms

Delay flight clearance. Consider that:

• Initial X-rays can miss occult fractures, particularly hip fractures (MRI may be needed if pain persists) 1
• Patients with prolonged downtime after a fall require comprehensive assessment for rhabdomyolysis, dehydration, and occult injuries 2
• A complete head-to-toe examination is mandatory to identify missed injuries 2

If X-Ray is Normal AND Patient Meets Safety Criteria

May consider clearance IF ALL of the following are met:

• Patient can pass the "Get Up and Go" test (rises from chair, walks steadily, turns, returns, and sits without assistance) 2
• No orthostatic hypotension (check orthostatic vital signs) 2
• No cognitive impairment or confusion 1, 2
• No ongoing pain that limits mobility 2
• Underlying cause of fall has been identified and addressed 2
• Adequate time has passed since ED discharge (ideally >48-72 hours to ensure no delayed complications) 1

Specific Fitness-to-Fly Assessment Required

According to IATA medical manual criteria, medical clearance by the airline's medical department is required if the passenger: 1

1. Is incapable of caring for himself and requires special assistance (likely applies if he cannot ambulate independently)
2. Has a medical condition which may be adversely affected by the flight environment (hypoxia, immobility, dehydration risk)
3. Is likely to be a hazard or discomfort to other passengers (if requiring significant assistance or pain management)

If any of these apply, the patient must submit a Medical Information Form (MEDIF) to the airline for clearance. 1

Age-Specific Risks During Air Travel

At 86 years old, this patient faces heightened risks during flight: 1, 2

• Dehydration risk from low cabin humidity (5-20%), which can cause cognitive decline and orthostatic hypotension 1
• Immobility complications including DVT risk (though this is more relevant post-operatively) 1
• Delirium risk if recently hospitalized, especially with environmental changes and stress of travel 1
• Fall risk during boarding/deplaning and turbulence, particularly if balance is already compromised 2

Medication Review is Mandatory

Before any flight clearance: 2

• Review ALL medications (prescription, OTC, supplements)
• Polypharmacy (≥4 medications) independently increases fall risk 2
• High-risk medications include vasodilators, diuretics, antipsychotics, sedative-hypnotics, benzodiazepines, and antidepressants 2
• Adjust or discontinue medications that may have contributed to the fall 2

If Cleared to Fly: Essential Precautions

Should clearance ultimately be appropriate, implement these measures: 1

• Request wheelchair assistance at both departing and arriving airports 1
• Book early boarding to allow extra time 1
• Reserve aisle seat for easier lavatory access 1
• Ensure adequate hydration during flight (avoid alcohol and excessive caffeine) 1
• Have a travel companion if any functional limitations exist 1
• Inform cabin crew of recent fall and any limitations 1

Common Pitfalls to Avoid

• Discharging/clearing a patient who fails the "Get Up and Go" test markedly increases immediate fall risk 2
• Failing to perform complete head-to-toe examination can miss occult injuries 2
• Overlooking medication review, especially in patients on ≥4 medications 2
• Assuming "normal X-ray" rules out all injury (occult fractures may require MRI) 1
• Not investigating the underlying cause of the fall (cardiac, neurologic, medication-related) 2

Bottom Line Recommendation

Without knowing the X-ray results, current functional status, and underlying cause of the fall, this patient cannot be cleared for air travel. At minimum, you must:

1. Review the actual X-ray findings
2. Perform a "Get Up and Go" test
3. Check orthostatic vital signs
4. Complete medication review
5. Identify and address the cause of the fall
6. Ensure at least 48-72 hours have passed since ED discharge to monitor for delayed complications

If the patient has any fracture, cannot ambulate independently, or has unexplained syncope/cardiac symptoms, flight should be postponed until medically stable and cleared by the treating physician. 1, 2