While fall precautions may including common sense precautions such as: staff assistance, walkers or modification of bed heights--- new research suggests that nursing homes need to begin evaluate patient's use of common antidepressants known as selective serotonin reuptake inhibitors (SSRI's) which dramatically increase a patient's risk of falling.

A recently published study in the British Journal of Pharmacology conducted by clinicians in the Netherlands followed a group of 248 nursing home patients diagnosed with dementia over a two-year period. 

While nearly all of the patients experienced some type of fall during the course of the study, the study concluded that patients taking SSRI's had a notably higher incidence of falls compared with their peers who were not taking the drug.  Even more alarming, was that fact that researchers determined that patients taking SSRi's (common drugs include: Paxil, Zoloft and Prozac) were three time more likely to suffer a fall-related injury such as a hip fracture, leg fracture, bruise or wound.

Though not the primary focus of the study, an incidental finding was that patients taking SSRI's combined with sedatives and hypnotic drugs-- commonly given to patients to aid with sleep--- resulted in an ever further elevated rate of fall-related injuries.

While the this similar studies will no doubt need to be completed on a broader scale, mounting evidence suggests that all medications prescribed to nursing home patients should be evaluated to determine their necessity.  Further, given the suggestive data from this recent SSRI study, nursing homes need to heighten their focus on patients' medications when tailoring a fall-prevention protocol.

Related:

Study Links Medication Use With Falls

Half Of Nursing Home Residents Wrongly Drugged

Antidepressants may raise fall risk in nursing homes USA Today

Falls in older people: epidemiology, risk factors and strategies for prevention (PDF) LAURENCE Z. RUBENSTEIN Age and Ageing 2006; 35-S2: ii37–ii41 doi:10.1093/ageing/afl084

An unknown risk

Probably the last thing patients and families consider when selecting a facility is the possibility of violence--- perpetrated by another patient at the facility!  Leaving families further in the dark is the fact that poor decision making on the part of the facility significantly increases the risk of violence to their loved one.

As a nursing home lawyer who has seen the ramifications of poor decision making on the part of nursing homes, I’ve seen too many occurrences of patient-on-patient abuse go deliberately ignored by the facility out of embarrassment or fear of a poor public image.

Any type of violence involving nursing home patients should be considered a crime and deserves to be fully investigated by law enforcement officials as opposed to people working for the nursing home.  What makes situations involving violence committed by nursing home patients unique-- and frequently difficult to prosecute-- is that it takes place behind closed door in the privacy of a nursing home.

Of course, it is unreasonable to suggest that nursing homes should be strictly responsible for the acts of all their patients. However, things change when facilities begin to have information regarding patient’s aggressive or violent tendencies.  Once a facility learns of a patient’s behavior, they inherently have a duty to take necessary steps to protect other patients and staff.

A legal duty to protect

This isn’t just the patient advocate in me talking, Federal Regulations both prohibit abuse (F-tag 223) and require nursing homes to permit law enforcement to investigate situations involving injuries (F-tag 226).  With respect to f-tag 223, the regulation requires that a resident of a nursing facility has the right to be free from verbal, sexual, physical, and mental abuse, corporal punishment, and involuntary seclusion.

It is simply not acceptable for nursing homes to shrug their shoulders, when it comes to a situation where a patients is beaten.  The language from f-tag 226, requires nursing homes to report patients injuries (abuse) to regulatory agencies so an investigation can be done to determine how the patient was injured.

Basic precautions

As common sense would indicate, keeping patients with aggressive tendencies and psychological disorders away from other frail patients would be an important first step towards minimizing the risk of injury.  However, in situations when patients have ongoing problems, it is incumbent that facilities provide ongoing monitoring of the patients and seek to have the patient removed from the facility to ensure the well being of all.

While certainly a consistently disturbing picture, injuries resulting from the violence of other patients may indeed open the door to liability against the facility.  While pursuing a claim against a facility may be a distant afterthought following a violent episode following an injury, reporting the incident to police authorities, both provides the best opportunity to conduct a complete examination for purposes of both civil liability as well as ensuring other patients remain safe from similar behaviors.

Related:

Elder Abuse: Violence Among Elderly Nursing Home Patients

Nursing Home Abuse: Hidden Camera Catches Nurse Yanking The Wheelchair Of A Disabled Patient

Sexual Assaults In Nursing Homes, Not Exactly A Pleasant Topic-- But Is An Issue That Needs Attention

Patient Beaten To Death At Nursing Home With Long History Of Safety Violations. Should This Facility Really Be Considered A Skilled Nursing Facility Or Simply A Haven for Thugs?

Fall No. Assault Yes. Death Of Chicago Nursing Home Resident Under Investigation

In other words, due to the patient's weakened state, the bone likely fractured simply as a result of the person's own weight, taking a particular type of medication or as a result of their own movement that may have put awkward pressure on a particular area.

While there indeed may be situations where fractures occur for the reasons mentioned above, many experts in the medical community will agree that such instances of spontaneous fractures are quite rare.  Having prosecuted cases involving a fracture of unknown origin, I frequently consult with orthopedists or other physicians who can examine a patient's x-rays to evaluate if the fracture was related to trauma.

Particularly with disabled patients who may be unable to articulate how an incident occurred, the examination of x-rays and other radiological evidence is absolutely crucial to establishing that from a medical perspective such fracture could not have occurred absent intervention from staff or other patients.

Investigators from the California Department of Public Health apparently didn't buy the assertions made by Creekside Care Center in Stockton, CA that the thigh bone in a wheelchair-bound patient broke without any explanation or trauma. The patient died several days after the apparent incident at a nearby emergency room from cardio-respiratory distress--- attributed to the fracture.

After evaluating the 2008 incident, officials issued a AA citation and $100,000 against the facility.  Read more about this incident involving a fracture of unknown origin here.

Related Nursing Homes Abuse Blog Entries:

Nursing Home Abuse: Facility Allows Patient To Cry In Pain At Fractured Leg Goes Ignored--- For 24 Days!

Determining The Type Of Fracture A Person Has Sustained Can Reveal If Nursing Home Abuse Is Responsible

Nursing Home Patients With Osteopenia May Suffer More Severe Injuries During Falls

I'm not sure if it derives out of shame, fear or just plain laziness--- but I regularly see situations where a patients complaints of pain following an obvious injury, go ignored by the facility.  

A recent horrific example of ignored patient complaints came from our peaceful neighbors to the North.  Thestar.com reported on the case of a woman at a Canadian nursing home, that went 24 days without so much as an x-ray of her leg after she fell from her wheelchair and screamed in pain. 

Finally, after 24 days of pleas from the patient's daughter and significant discoloration of the leg, the facility ordered an x-ray of the woman's leg--- which demonstrated that her tibia was indeed broken. 

Situations such as this should never occur in any patient.  In fact, in the states, such occurrences of uncontrolled pain are not only inexcusable--- but they are against the law!

Nursing homes have an obligation to provide pain relieving measures to their patients. While certain medical conditions such as broken bones and bruising may be obvious indicators that a patient was injured, nursing home staff must also be diligent to look for signs of distress in patients with less visible condition that require pain relief.

With disabled nursing homes patients, staff should take note of patients facial expressions, involuntary motor actions, moans and changes in behavior as potential indicators that the patient may indeed be suffering.  After noticing these signs, the staff should timely contact the patient's physician.

The recognition of a patient's pain and subsequent pain relief is required pursuant to Federal Regulation of nursing homes. F-Tag 309 (Quality of Care) requires nursing homes to provide 'necessary care and services to attain or maintain the highest practical physical, mental and psychological well being, in accordance with the comprehensive assessment and plan of care.'

Despite some ambiguity as to the significance of 'highest level of practicable care' really means, the interpretive guidelines to F-Tag 309 provide more specific guidance for providing pain relief and unquestionably requires nursing homes to both monitor patients and provide them with sufficient pain relieving measures.

Related:

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

Nursing Home Patient With Broken Hip Sits In Pain. Why Federal Law Requires Staff To Administer Pain Medication

Some Nursing Homes Seem To Have A 'Wait And See' Approach When It Comes To Getting Medical Treatment For Their Injured Patients

Sure, the implementation of educational programs at nursing homes my help get patient safety back into the minds of staff members, but even the best safety programs require careful and conscientious staff to see that that are properly implemented.

In this sense, one of most disturbing trends I am seeing--- particularly, amongst patients in nursing homes and hospitals--- is patients getting injured while they are being transported in the facility by staff.  

That's right, the CNA's and other custodial staff responsible for carefully pushing the wheelchairs or stretchers, I'm seeing the most basic precautions thrown out the window as staff hastily move patients about.  Over the past six months alone, I've seen situations involving patient injury that really derive from sloppiness on the part of staff including:

• Patients thrown out of beds and wheelchairs because wheel-locks weren't engaged
• Patients falling out of beds because side-rails were never raised
• Staff not properly assembling beds and wheelchairs
• Staff failing to secure patients arms and legs in wheelchairs thereby allowing them to get caught or tangled on other other equipment
• Staff failing to load patients in elevators properly- allowing doors to close on them
• Patients being left unattended to in cluttered areas

Though many of these situations seem far-fetched and somewhat laughable, they indeed are the very real culprits of real injuries-- sometimes far more disabling than more traditional conceptions of nursing home negligence or medical malpractice.

However due to the very real nature of these sloppy patient-safety injuries--- sometimes involving fractured bones, dislodged medical devices, subdural hematomas-- or even death, it is crucial to evaluate these with the same zealousness as any other type of injury related case involving a nursing home or hospital. 

Particularly given the fact that most of these situations will occur 'behind the closed doors' of the medical facility, it is important to both recognize the potential significance of the injury and seek medical treatment as soon as feasible secondly bring the situation to the attention of staff at the facility to assure there is some documentation related to the event. Don't be victimized twice for an employees plain old carelessness.

Related:

Improper Maintenance Of Lift Device Costs Nursing Home Patient Their Life

Medical Facilities Must Use Wheel-Locks & Supervision To Protect Patients In Wheelchairs

Rosenfeld Injury Lawyers: Hospital Negligence

Nursing Home Patients Transported In Vehicles Are At Risk For Injury When Safety Is An Afterthought

When facilities fail to take basic steps to safeguard patients from these environmental hazards, we frequently see patients getting severely injured or killed.

A recent example of nursing homes failure to take basic precautions to safeguard a patients comes from a Missouri nursing home, where a wheelchair-bound patient was left unattended-- and without engagement of wheel lock-- in a stairway at the facility. 

Stltoday is reporting that the above circumstance forms the basis of a lawsuit against Avalon Garden Nursing Home (Missouri) filed on behalf of the Estate of Magdalen Mantych who died following a February 20, 2008 fall down a stairway at the nursing home. Ms. Mantych suffered a broken neck and blunt head trauma in the fall and died three days later from complications related to her injuries.

In my opinion there is simply no excuse for facilities allowing wheelchair patients unrestricted access to stairways.  As a nursing home lawyer, I have been involved in numerous cases where patients have suffered horrific injuries following a fall down and interior or exterior stairway.  Certainly, staff at these facilities need to be reminded how susceptible many of these patients are and remove patients from these hazardous situations before they harm themselves.

Related Nursing Homes Abuse Blog Entries:

Falls Amongst The Elderly Can't Be Ignored

What Are The Rights Of A Nursing Home Visitor Who Sustains An Injury During A Visit?

Fall Leaves Veteran With Broken Neck In Illinois Nursing Home

Wheelchair-Bound Nursing Home Patients Must Be Properly Supervised To Avoid Injury

Nursing Home Injury Laws: Missouri

The results of the study were discussed in a New York Times article, "Narcotic Painkillers May Pose Danger to Elderly Patient, Study Says," and the overwhelming conclusion was that narcotic painkillers put seniors at an increased risk for: bone fractures, heart attack and death compared to milder, over-the-counter pain relief medications such as Advil and Motrin.

In reaching its conclusions, the study analyzed the records from a group of women who were diagnosed with different types of arthritis, using varying types of pain medication, over a six-year period.  

Based on data in the patients medical records, patients who took narcotic-based pain medications were at a significantly higher risk for medical complications compared with their peers using other types of medications.  

While, researchers look closer at the underlying reasons for the increased rates of patient injury, I think this study should give patients reason to pause and re-consider the medications they are taking with their physicians to assure all medications are necessary and in the proper dosage.

Depending on the patients size and ability to move themselves, one or more staff members may be required to assist in the repositioning process.  Regardless of how many staff are involved in the repositioning process, moving patients should be done gently as feasible to avoid alarming them to make sure any rigid limbs (contractures) do not get caught in the process.

Along these lines, a nursing home negligence lawsuit filed against an Illinois nursing home now claims that the staffs' negligence in repositioning is to blame for the leg and knee fractures of an elderly woman.  

The lawsuit names The Lincoln Home Inc. (Belleville, IL) and Weiss Management Group Inc. in the lawsuit that is filed in St. Clair County.  In addition to the alleged improper care that resulted in the initial injuries, the lawsuit further alleges that the nursing home made the patient's injuries worse (and caused her unnecessary pain) because they substantially delayed in obtaining medical treatment for her despite her obvious injuries.

Even after the woman was at the hospital, Lincoln Home allegedly continued to act inappropriately by sending a representative to the woman's hospital room to get her to sign a statement related to the incident when she was heavily medicated.

Improperly Trained Nursing Home Staff

Admittedly, I don't have much information about this incident involving The Lincoln Home, but I have worked on cases where inadequate staff training is responsible for injuries to patients during re-posiitioning maneuvers and transfers into and out of a bed.

In some cases, I was surprised to learn that the nursing home never instructed the staff on proper lifting technique nor safety precautions to take before doing so.  I share the frustration of residents and families where a needless injury occurred due to the fact that staff were never give proper instruction to do their job.  

Hopefully lawsuits, such as the one initiated against The Lincoln Home, will encourage facilities to make patient safety a primary issue in staff training.

Related:

Nursing home resident alleges staff failed to do anything about her broken leg The Record, October 28, 2010 by Andrea Dearden

Determining The Type Of Fracture A Person Has Sustained Can Reveal If Nursing Home Abuse Is Responsible

Osteoporosis Puts Nursing Home Patients At A Heightened Risk For Fractures Related To Falls

The Lincoln Home

• Lincoln Home IDPH Survey 1.29.09 (PDF)
• Lincoln Home IDPH Survey 3.2.09 (PDF)
• Lincoln Home IDPH Survey 5.29.09 (PDF)

As we age, our bones become weaker and are more susceptible to dangerous bone breaks. This is because older bones form small cracks more easily, which makes bone breaks more likely. 

In order to prevent dangerous bone breaks-- and to help determine fractures that may be the result from situations involving nursing home abuse-- it is helpful to understand the types of fractures and what causes them. Common types of bone fractures include:

• Stress fracture
• Spontaneous fracture
• Compression fracture
• Traumatic fracture

Stress Fracture

Stress fractures are actually tiny cracks in bones caused by overuse and repetitive motion. They occur mostly commonly in the lower-legs and feet because these are weight-bearing bones. Stress fractures may be barely noticeable at first, but the swelling and pain will intensity as they worsen. Therefore, it is important to receive proper care and treatment to prevent the stress fracture from becoming more serious. 

As with most bone breaks, osteoporosis or weak bones increases your chance of suffering from painful stress fractures. And, to further complicate matters, a study indicated that some post-menopausal women who take biophosphonate drugs such as Actonel, Boniva, Fosomax, and Reclast might actually have a higher risk for hip fractures. (See “Study Links Commonly Prescribed Osteoporosis Drugs To An Increase in Hip Fractures”) It is important to discuss any new medications with your doctor, who will help you weigh the benefits and risks of drug treatment. 

In a nursing home setting, staff members should be aware of the signs of stress fractures, so a resident’s care plan can be altered to prevent further damage and alleviate pain. Signs and symptoms are swelling and pain, especially in the lower legs and feet. Nursing home staff or doctors use x-rays to diagnose stress fractures. 

Early treatment of stress fractures is important, so the cracks do not worsen. Treatment includes reduced activity until the bone has a chance to heal. However, some stress fractures are harder to heal and are prone to re-injury. Therefore, it is important that nursing home staff monitor the resident’s injury to ensure that proper healing occurs.

Spontaneous Fracture

Spontaneous fractures (also known as compression fractures) are bone breaks that occur without trauma in what seem like normal bones. The spine and hips (bones that directly support your weight) are the bones most likely to be affected by spontaneous fractures. Older bones are more vulnerable to compression fractures because they lack the internal support structures to withstand impacts and pressure. Osteoporosis (weak and brittle bones) is the most common cause of spontaneous fracture. 

A 10% bone mass loss in the vertebrae can double the risk of vertebral fractures and a 10% loss of bone mass can increase your risk of hip fracture (2.5 times greater chance of hip fracture). Hip fractures are one of the most common injuries for elderly people. They usually occur because of a fall and can cause serious and even life-threatening medical complications. 

While walking exercises are often valuable tools to help maintain health (bone health) and promote strength, strenuous walking exercises can contribute to spontaneous hip fractures. Therefore, it is important to personalize individual walking plans for elderly residents according to their bone health, which can be determined by BMD (bone mineral density) tests. 

Hip fractures usually require surgery to realign the bones, often with surgical screws, metal rods, or plates. Then, after surgery the main focus is on controlling pain and preventing infection. The best thing to do after hip surgery is to start moving around as soon as possible. This helps reduce recovery time and prevent dangerous complications such as blood clots, lung congestion, and pressure sores. 

Oftentimes, a walking aid (walker, crutches, or cane) is used in the months following surgery. Physical therapy will help the resident regain their strength and independence. However, many elderly nursing home residents are never as independent as they were before their hip fracture. And, if the resident makes no improvements, physical therapy is often cut short. 

Elderly persons can also suffer from compression fractures in their spine, which occur when the vertebrae (back bones) become so weak that they compress or collapse. Again, osteoporosis is the main cause of vertebral compression fractures. A compression fracture of the spine can cause severe pain and a stooped posture or even a hunchback (kyphosis). While this type of compression fracture will often heal on its own after 8-12 weeks, previous spinal compression fractures increase your chance of suffering from additional compression fractures of the spine. 

Trauma Fracture

Elderly people are susceptible to dangerous falls because of poor balance and coordination, weakness, changes in gait, poor vision, illness, medications that cause sleepiness or dizziness. Over 11 million people over the age of 65 suffer dangerous falls every year. That is an astonishing one out of every three senior citizens. 

Your wrists and hips are the bones most likely to break if you suffer from a fall. Your wrists are susceptible to breaks from bracing yourself with your hands as you fall. And, your hips are more susceptible to breaks because as you age your bones (especially your hips) are less able to withstand impacts, and your hips often receive the brunt of the impact when you fall. 

After an accident or fall, nursing home staff members will examine the injured area to look for bone breaks, cuts, bruising, or other signs of injury. The staff will ask questions and investigate how the injury occurred. This investigation into the cause of the fall is very important to protect the resident and prevent future falls. 

If the resident lost consciousness, this could be a sign of a more serious condition, such as a stroke or heart attack. In the case of a possible bone break, the resident will be treated by a physician who will determine whether x-rays are necessary. The doctor will use a splint or case to immobilize bone breaks that occur on the arms, legs, hands, and feet.  However, as discussed above, hip fractures usually require surgery and post-operative physical therapy to help improve mobility. 

Understanding the significance of each type of fracture

Understanding the different types of bone fractures can help prevent dangerous bone breaks by avoiding dangerous situations and taking preventative measures. Nursing home facilities are required to keep the facility free from accident hazards and take preventive measures to prevent dangerous falls. 

Each resident should have an individual care plan specifically tailored to their strengths and weaknesses in order to provide the best care possible. If you or a loved one suffered a dangerous bone break while a resident at a nursing home facility, you may be entitled to compensation. 

Sources:

Nursing Homes Abuse Blog: Study Links Commonly Prescribed Osteoporosis Drugs to an Increase in Hip Fractures

Merck: Fractures

Amherst Bulletin: When Seniors Fall, Perilous but Preventable

e-Medicine: Lumbar Compression Fracture

Mayo Clinic: Stress Fractures

Journal of Orthopedic Surgery: Strenuous walking exercise and spontaneous fracture of the femoral neck in the elderly

Medicine Net: Fracture

WebMD: Understanding Fractures

Pub Med: Spontaneous fracture – multiple causes

While there may be a number of reasons why elder abuse goes unreported, a primary reason the article points to is the fact that most elder abuse is perpetrated by caregivers who control the individuals access to the outside world-- and hence their ability to report the abusive situation to authorities and/or allow others to notice the abuse and report it to authorities.

Importantly, the article also points out that there are varying types of elder abuse aside from flat out assault or battery of an elder.  Other types of abuse such as intentional isolation or neglect are common situations encountered by the elderly reliant on a facility or caregiver for their daily living needs.

Similarly, many elders are frightened to report abusive situations involving caregivers because they fear they may be retaliated upon for coming forward with the abuse.

Hopefully, articles such as this will direct more attention to this important issue.  Too often, I see well-meaning caregivers and families living in denial with respect to the fact that their loved one is as risk for abuse or neglect.

Hopefully, articles such as this will provide a needed wake-up call for families and caregivers and perhaps cause them to be more aware of potentially abusive situations.  Common indicators of elder abuse include:

• Unknown bruising / fractured bones
• Sudden change in behavior
• Change in sleeping patterns
• Withdrawal
• Large withdrawals from financial accounts
• Dirty living conditions
• Bed sores

As I have been witness, when authorities are contacted as soon after a suspected incident as possible, they are most likely to be successful in determining the abusive perpetrators.  Unfortunately, as times goes on, memories fade and valuable evidence has a way of disappearing. 

Related:

Investigations May Not Always Hold The Answers To How A Nursing Home Injury Or Death Occurred

Elder Abuse: Why Bruises Can Be Tell-Tale Signs Of Poor Care

6 Most Common Causes Of Bed Sores & How Caregivers Can Help

The Real Devastation Associated With Sex Abuse In Nursing Home Will Never Be Known As Most Acts Go Un-reported & Un-prosecuted

In my nursing home ligation practice, I see many cases where nursing home patients are horribly injured in car accidents either as pedestrians or as passengers.  While most think about nursing home patients passing time in an idyllic setting, the truth is that there is a significant portion of the nursing home population that leaves the facility for their personal recreation, visit with doctors or tend to personal business. 

Because auto accidents make up a significant number of accidents for nursing home patients, I plan on going into the three major categories of automobile injury cases affecting nursing home patients and the respective liability issues for both driver and nursing facility.

As I see it, nursing home patients are involved in injuries due to: other drivers (pedestrians), passengers in vehicles or in the case of dementia or Alzheimer's patient-- wandering from the facility.

Elderly pedestrians involved in auto accidents

Many nursing homes are located in metropolitan areas where vehicle traffic is heavy.  Though the centralized location may be convenient for family and visitors, busy city environments are particularly dangerous to elderly nursing home patients who walk or roll along the street in wheelchairs.

The constant traffic and rapidly changing traffic controls can be substantial obstacles for everyone, but particularly those with special needs such as elderly people with assisted walking devices or diminished hearing or eyesight. 

Several years ago, my office represented an elderly man, who happened to be a nursing home patient, who was struck by a truck making a right-turn as he made his way to a convenience store literally located across the street from the nursing home.  The man suffered severe orthopedic injuries to his legs-- bilateral femur fractures and de-gloving injuries when he was thrown from his electric wheelchair and run over by the rear wheels of the truck. 

Though the man's family initially contacted us as a perspective negligence claim against the nursing home where he resided, we quickly learned that the truck-driver was really the one who was responsible for accident and the man's injuries.  In the course of litigation, the truck driver acknowledged that he was unable to see the elderly man due to the height of his truck and the relatively low height of the electric wheelchair-- despite the fact that that the man was in the cross walk and obeying the traffic signal.

Pedestrians have the right of way

Most jurisdictions have traffic laws that give pedestrians-- even those with physical disabilities-- the right of way when sharing the road with automobiles.  In this context, the driver of the vehicle is usually the one primarily responsible for resulting injuries especially if the pedestrian was obeying the traffic signals.

In some circumstances following a collision with a pedestrian, an assertion may be made by the offensive driver that the person was too old or had diminished senses.  In my experience, such arguments typically backfire-- badly. 

Not surprisingly, in most elderly-pedestrian vs. auto collisions, I see the real fault falling lying on the drivers who fail to keep a proper look out or who refuse to wait the literal seconds it takes for a person to get out of harms way.

Liability of nursing home or driver?

In situations where a pedestrian really has no business walking around unassisted, there may be a cause of action against the facility where he or she resided for the facilities failure to provide assistance.

However, if a nursing home patient is capable of appreciating the risks associated with walking around, they certainly should be entitled to do so.  

Particularly with elderly pedestrians, the resulting injuries sustained in automobile accidents can be devastating.  Unlike similar accidents occurring in a younger population, older people tend to heal-- far slower and require much more extensive care.

As lawyers who have championed the rights of the elderly for more than 30 years, we have developed a unique perspective on the overall effects of injuries on aged bodies.  In many respects our appreciation for the severity of the injuries sustained by the older population has resulted in verdicts and settlements admired by our peers in the legal community.

If you or a elder was involved in an auto accident, I invite you to speak with our elder law attorneys to discuss your legal options.  All consultations are free of charge and completely confidential.  (888) 424-5757

Resource articles:

Accidents involving older people: a review of the literature
JM Lilley, T Arie, CED Chilvers - Age and Ageing, 1995 - Br Geriatrics Soc

Toleration of head injury by the elderly
LA Amacher, DE Bybee - Neurosurgery, 1987 - journals.lww.com

Injuries in restrained motor vehicle accident victims
GW Hendey, SR Votey - Annals of emergency medicine, 1994 - Elsevier

Injuries to the elderly in the traffic environment
H Sjögren, U Björnstig - Accident Analysis & Prevention, 1991 - Elsevier

Bone health is a serious concern for older adults. As you age, your bones get weaker as they lose their internal support structures. Older,

Osteopenia is a lower than normal peak bone mineral density (BMD). While not as severe as osteoporosis, it does increase your risk for osteoporosis. Bone mineral density is an indicator for how strong and healthy your bones are. BMD peaks in your late 20s to early 30s, after which it starts to decline. If your BMD is between 1.0 and 2.49 standard deviations below the average peak BMD, you suffer from ostenpenia. 

Women have a lower peak BMD than men and menopause causes hormone changes that speed up the loss of bone mass, which increases their risk of developing osteoporosis and osteopenia. In the United States, about 30% of Caucasian postmenopausal women in the United States have osteoporosis, and 54% have osteopenia.

For older adults, proper bone health is not just a matter of maintaining overall health; proper bone health can also affect mobility and independence. It is never too late to take steps to improve or maintain good bone health in order to prevent dangerous fractures. These lifestyle changes include:

• Receiving proper levels of calcium in your diet (maybe including a calcium supplement combined with vitamin D)
• Not using tobacco products (they can weaken bones)
• Not consuming excessive amounts of alcohol
• Exercising and remaining active (bone forms in response to stress, so weight-bearing exercises are good choices)
• Taking caution to avoid dangerous bone breaks
• Getting early treatment for eating disorders (low body weight can increase the risk of hip fracture)

Osteopenia does not have any symptoms, but doctors can diagnose low BMD with a bone density scan. This can help you and your doctor decide if bone strengthening drugs are an appropriate treatment option. Many women who have menopause also have osteopenia. 

Some doctors recommend osteoporosis medicine including Fosamax, Boniva, or hormone therapy right away to prevent further bone loss. However, as with any medication, these drugs have side effects and associated risks. Other doctors recommend that you exercise and take calcium. And, some researchers caution that many younger postmenopausal women are taking drugs that they don’t need because osteopenia is just a risk marker for osteoporosis. 

The World Health Organization developed a tool that helps predict a person’s overall risk of major fracture over the next 10 years by factoring in a variety of risk factors including: age, bone mineral density test results, family history of osteoporosis, use of oral steroids, whether or not you have rheumatoid arthritis, and whether or not you smoke. And, the National Osteoporosis Foundation revised its treatment guidelines as follows: drugs should be considered for postmenopausal women and men age 50 and older who have a 10-year probability of a major osteoporosis-related fracture ≥ 20% or a 10-year probability of hip fracture of ≥ 3%. 

If you or a family member is a nursing home resident it is important to ensure that you are receiving adequate calcium in your diet and proper activity and exercise to promote bone formation. Also, if you have risk factors for osteoporosis, you should have a bone mineral density test performed in order to determine your chances of developing osteoporosis and suffering dangerous bone breaks. Your bones are an important factor in maintaining independence and mobility, and nursing homes should ensure that you maintain proper bone health. If you are worried that a family member not receiving proper nutrition or BMD testing, it is important to talk with the nursing home staff as soon as possible to address the problem. 

Sources:

WebMD: Osteoporosis Health Center - Osteopenia

University of Washington: Department of Radiology – Osteopenia

U.S. News: Health – Grappling with a diagnosis of Osteopenia

Better Bones: Rethinking Osteoporosis

Pub Med: Vitamin K deficiency and osteopenia in elderly women with Alzheimer’s disease

JAMA: Osteopenia and Preventing Fractures

While the drugs are commonly prescribed to maintain bone strength in older women, the study demonstrated that when the drugs are taken for more than 5 years, the incidence of hip fractures begins to increase in the group of women who take the drugs compared with women who were not taking the drugs.

"These drugs are good drugs.  They strengthen bone and protect you from fractures for a while.  But in some people that can become deleterious after a period of time," according to Melvin Rosenwasser, chief of orthopedic trauma surgery at Columbia Medical Center in New York.

At this point, the FDA has not reviewed the studies nor has the agency issued any recalls with respect to the drugs involved in the study.  Rather, if you are taking any of the aforementioned drugs, you should discuss the use with your doctor and make a determination as to what works best for your situation.

Read more about the study linking osteoporosis drugs with hip fractures here.

Hip Fractures In The Elderly

As a nursing home lawyer, I have worked on many cases involving hip fractures as a consequence of falls.  Unfortunately, hip fractures typically require surgical repair in order for the patient to regain any quality of life post-fracture.  An estimated 300,000 people undergo surgery for hip fractures every year.

Most hip fractures fall into two categories:

Femoral Neck Fracture

A femoral neck fracture occurs when the ball of the ball-and-socket hip joint is fractured off the femur. Treatment of a femoral neck fracture depends on the age of the patient and the amount of displacement of the fracture.  A partial of full hip replacement may be necessary in patients who sustain a femoral neck fracture because of diminished blood flow makes healing of the area affected by the fracture unlikely.

Intertrochanteric Hip Fracture

An intertrochanteric hip fracture occurs just below the femoral neck. These fractures are amenable to repair more often than femoral neck fractures. The usual surgical treatment involves placement of a plate and screws to stabilize the fracture as opposed to a partial or complete hip replacement.

Hip fracture surgery complications

The good news is that modern medicine is capable of treating many types of hip fractures.  However, data has shown us that many elderly people have an incredibly difficult time recovering from hip fracture procedures.  In fact, an estimated 30%+ of people over 60 will die in the year following their procedure. 

All this means that nursing homes and other care facilities should take all possible efforts to implement fall prevention programs to reduce the risk of falls in their patients.

Related Nursing Homes Abuse Blog Entries:

Bone Fractures In The Elderly Require Special Attention To Improve Recovery & Prevent Complications

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Nursing Home Patients Have More Post-Surgical Complications Than Their Peers

A Video Diagram Of A Hip Replacement Surgery

The law has a long-standing tradition where a defendant (wrongdoing person or facility) takes the plaintiff (injured person) as they find him or her.  In other words, the fact that a person was in a weakened state at the time of their injury really has no bearing on the case, except for the fact that the resulting damages from their poor care may be more extensive for a person in a weakened condition than if the injury occurred to a younger person without such complicating factors.

Without a doubt, complications from brittle bones are one of the most problematic things facing many nursing home patients who suffer a fall at a facility.

What is Osteoporosis?

As you age, your bones get weaker, increasing your risk of osteoporosis (a disease that causes weak, porous bones). This can significantly increase your risk of dangerous bone breaks (fractures). Weak bones are caused by low levels of calcium, phosphorous, and other mineral levels in the bone. This mineral loss causes your bones to become brittle and eventually lose their internal support structures. 

Approximately 44 million people (~ 55% of the U.S. population) in the United States suffer from low bone density and 10 million of those people actually suffer from osteoporosis. About 30% of Caucasian postmenopausal women in the United States have osteoporosis, and 54% have osteopenia (lower than normal bone mineral density). 

Signs and Symptoms of Osteoporosis

Osteoporosis does not usually have any signs or symptoms until it is pretty far advanced. Weakened bones can cause back pain, loss of height over time, a stooped posture, and broken bones. However, you can have osteoporosis for years without symptoms, until you suffer from a serious bone break. Therefore, you should have a doctor perform a bone density test if you are:

• A woman older than age 65
• A man older than age 70
• A person over 50 who has suffered from a broken bone during their lifetime
• A person who takes medications associated with osteoporosis (prednisone, aromatase inhibitors, or anti-seizure drugs)
•  A postmenopausal woman (when estrogen levels drop at menopause, bone loss increases dramatically) with at least one osteoporosis risk factor
• A postmenopausal woman who recently stopped taking hormone therapy
•  A woman who experienced early menopause

Risk Factors

There are some lifestyle related risk factors you can change to help improve bone strength, including:

• Low calcium intake
• Tobacco use
• Eating disorders
• Sedentary lifestyle
• Excessive alcohol consumption
• Corticosteroid medications

However, there are also risk factors that you cannot change, including:

• Being a woman  
• Aging
• Being of white or Asian decent
• Family history of osteoporosis
• Above normal levels of thyroid hormone
• Medical conditions and procedures that affect bone health (stomach surgery, Crohn’s disease, celiac disease, hyperthyroidism, and Cushing’s disease).

Prevention of Osteoporosis

Your bone mineral density (BMD) peaks when you are in your early 30s and starts declining as you age. Your likelihood of developing osteoporosis depends on how much bone mass you attained in your 20s and early 30s (the more bone mass you have, the less likely you are to develop osteoporosis) and how quickly you lose it. 

Prevention entails accumulating as much bone density as possible during your early life by eating healthy, getting enough calcium, being physical active, not smoking, and maintaining a healthy lifestyle and maintaining those practices during your later years. 

Increased risk of fractures related to falls in patients with Osteoporosis

Older, brittle bones are more vulnerable to serious bone breaks and compression because they lack the internal support structures to withstand impacts and pressure. Even a relatively mild injury can cause bone breaks. And, women suffering from osteoporosis are twice as likely to suffer from bone fractures when compared to men with osteoporosis. Older adults are at increased risk for dangerous falls because of balance problems, weakness, illness, bad vision,

Bone fractures are most common in the spine and hips (bones that directly support your weight), and the wrists (from bracing yourself with your hands as you fall). A 10% bone mass loss in the vertebrae can double the risk of vertebral fractures and a 10% loss of bone mass can cause a 2.5 times greater risk of hip fracture. 

Hip fractures are one of the most common injuries for elderly people. They usually occur because of a fall and can cause serious and even life-threatening medical complications. Elderly persons can also suffer from compression fractures in their spine, which occur when the vertebrae (back bones) become so weak that they compress or collapse. This can cause severe pain and a stooped posture. 

Osteoporotic bone fractures can cause decreased quality of life, severe pain, disability, and reduced mobility. Maintaining mobility is a significant concern as you age and healthy bones can help you maintain your health, safety, mobility, and independence. One of the best things you can do for yourself if take care of your bones at an early age by exercising, receiving adequate levels of calcium, eating a healthy diet, and not smoking. It is never too late to do something about your bone health. 

Therefore, nursing home staff should take steps to improve and maintain the bone health of all residents. Nursing home facilities should encourage safe and appropriate exercise and activity, provide proper nutrition, providing calcium supplements if necessary, and reducing the risk of dangerous falls.  

Fall prevention is one of the most important things nursing homes can do to ensure that residents do not suffer dangerous injuries. Osteoporosis and weak bones are common in many older adults, so preventative measures to protect the entire population is often the most effective tool to reduce complications for residents with osteoporosis. 

Your family member deserves to receive necessary and appropriate care to achieve and maintain their best possible physical health and well-being. Although your family member is older and aging, they still deserve to receive the steps and care necessary to retain their independence, health, and dignity. 

Lastly, should your loved one sustain an injury during an admission to a nursing home or assisted living facility, don't assume that their osteoporosis precludes them from pursuing a claim against the facility.  Rather, the resulting injuries may likely be compensable regardless of their physical condition at the time of the incident.

Resources:

International Osteoporosis Foundation

National Institute of Arthritis and Muscoskeletal and Skin Diseases: Osteoporosis

The Johns Hopkins Arthritis Center: Osteoporosis Information – A Geriatrician’s Perspective

Related Nursing Homes Abuse Blog Entries:

Nursing Home Sued After Resident Fractures Both Hips In Separate Falls

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

The 76-year-old patient fell and sustained her injuries while workers at Ridgeland Nursing and Rehabilitation Center were changing her bed at approximately 5 a.m.  A call for emergency assistance was not placed until 4:42 p.m.-- 12 hours later.

In situations like this, it obviously represents a complete failure in the system intended to protect these elderly people from harm.  Federal law requires nursing homes to treat and relieve pain.

According to Federal Regulations, F-Tag 309 (Quality of Care) requires nursing homes to provide 'necessary care and services to attain or maintain the highest practical physical, mental and psychological well being, in accordance with the comprehensive assessment and plan of care.'

As a nursing home lawyer, its easy for me to point the finger at the facilities errors when it comes to following protocols and federal regulations. From a human point of view, it truly is tragic to see medical professionals ignore a person in pain.

Unfortunately, the 'wait and see' reaction to injuries is becoming more common in nursing home injury cases.  We can only guess what transpired at the nursing home during the 12-hours the staff waited to get medical attention. It certainly would be interesting to get a 'call log' from the facility.  Do you think the staff placed a call to their attorneys during the 12-hours this patient sat in pain related to her fractures?

Related Entries:

Study Reveals Nursing Home Patients Chronic Pain Is Not Adequately Controlled

Nursing Home Patient With Broken Hip Sits In Pain. Why Federal Law Requires Staff To Administer Pain Medication

Bone Fractures In The Elderly Require Special Attention To Improve Recovery & Prevent Complications

In times of need, locating necessary information regarding the legal rights and resources for nursing home patients can be difficult and imposing.  In this respect, we are proud to introduce a new resource for patients, families and practitioners looking for a concise compilation of information regarding nursing home laws.  Nursing Home Injury Laws, provides every states':

• Nursing Home Laws
• Medical Malpractice Laws
• State Resources
• Applicable State Code
• Common Nursing Home Injuries
• Glossary
• Recognized Books & Journals
• Nursing Home FAQ

Additionally, we will be posting regular updates regarding important developments relevant to nursing home care within each state.  Here is a link to Nursing Home Injury Laws.

What is a fracture?

A fracture is a broken bone that requires medical attention. Fifty percent of women over age fifty and twenty-five percent of men over age fifty will suffer from an age-related bone fracture sometime in their lifetime.

Elderly people are particularly susceptible to broken bones because as bones age, they lose the ability to resist the formation and growth of cracks that can lead to bone breaks because they cannot withstand as much pressure as younger bones.  Unfortunately, as we age, our bodies ability to heal fractures is compromised.

Nursing home staff can take steps to help maintain bone health in elderly nursing home residents:

• Regular exercise
• Adequate amounts of calcium
• Adequate amounts of vitamin D (essential for calcium absorption)

Osteoporatic Nursing Home Patients and fractures

Elderly nursing home residents who have osteoporosis (porous weak bones) or other conditions that lead to weakened bones or decreased bone density are at risk for bone fractures. Weak bones have low levels of calcium, phosphorous, and other minerals in the bones, which makes people more susceptible to fractures because the bones are more brittle. 

Women suffering from osteoporosis are twice as likely to suffer from bone fractures than men with osteoporosis.  Fractures from osteoporosis are most common in the spine and hips (bones that directly support your weight), and the wrists from bracing. Therefore, nursing home staff should take extra precautions to prevent falls and provide adequate nutrition to maintain the well-being of residents.

Diabetic Nursing Home Patients and fractures

Many nursing home residents also suffer from diabetes. A recent study suggests that there is an association between a drug introduced in the 1990s to help treat type 2 diabetes (thiazolidinediones) and bone fracture. The increased risk of fracture increased as the duration of the drug treatment increased and was observed in both men and women. Therefore, nursing home residents who have been treated with this drug also might have a further increased risk of bone fractures. 

Medical treatment for fractures in the elderly

Treatment for bone fractures depends on the location of the break. For most fractures occurring in the arms, legs, hands, and feet, the initial treatment is splinting the injured limb and immobilizing the joints above and below an injury to prevent movement at the fracture site. Then, the splint is removed and replaced by a cast. 

Some breaks might also require surgery in order to properly align bone fragments, increase stability, and ensure that bones will heal properly. Some fractures might also require metal hardware (pins, plates, or rods) to hold the bones in place. Older adults heal slower than younger people, which can cause additional complications and mobility issues for nursing home residents. 

How we can help

Depending on the circumstances regarding the fractured bones, the medical facility may be responsible for the damages relating to the fracture.  In many cases, we have successfully recovered damages for our clients', medical bills, medical equipment, pain and disability.  If you believe that a nursing home is responsible for your broken bone, we would be honored to speak with you to discuss your legal rights. (888) 424-5757

Resources:

Mayo Clinic: Fractures

Lawrence Berkeley National Laboratory: Why Older People Suffer More Bone Fractures

Science Daily: Risk of Bone Fractures Associated with Use of Diabetes Drug

Related Nursing Homes Abuse Blog Entries:

Nursing Home Staff Must Take Precautions While Moving & Transferring Disabled Patients To Minimize Risk Of Dropping

Fall In Stairwell Results In Paralysis-- And Ultimately Death Of Chicago Nursing Home Resident

Nursing Home Sued After Resident Fractures Both Hips In Separate Falls

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

The most dangerous part of the day for many nursing home patients may be getting out of bed in the morning.  When staff fail to supervise or provide proper assistance to nursing home patients during transfers, patients are at risk for falls or being dropped by staff.

Disabled nursing home patients and those with physical limitations must be carefully monitored to avoid injuries while being transferred from one device to another.  Some of the commonly encountered situations where patients are injured include:

• Bathing: facilities failing to provide assistance or provide specialized bathing equipment including chairs, stands and grips
• Transfer into and out of bed
• Failing to take extra-precautions with patients who may have uncontrolled muscle movement: many times these patients require special restraints during transfers
• Failing to take patient medications into the equation: some commonly prescribed medications can make patients dizzy or cause blood pressure spike or drops when patients are moved
• Failing to engage locks on wheelchairs
• Allowing patients to wear socks or improper footwear during transfers
• Failing to monitor patients with walkers

Although facilities like to claim that these incidents are isolated events, a dropped patient is usually indicative of poor staff training and chronic under-staffing.  Most of these transfer-related incidents occur due to:

• Poorly trained staff: Some facilities do not properly train staff in how to use equipment
• Under-staffing: Facilities sometimes to not have enough man power to safely perform transfers as they were intended
• Wrong equipment: facilities must have the proper equipment for the job
• Faulty equipment: facilities must keep equipment in proper repair.  This includes getting replacement parts from the manufacturer
• Failing to provide timely assistance to patients who request it

Cases involving injury or death during transfer are particularly important to investigate as quickly as feasible after the incident in order to preserve the condition of equipment and to obtain statements from witnesses others who may have knowledge of the event.  

If your loved one suffered an injury or died as a result of a fall or being 'dropped' by staff, we would honor the opportunity to speak with you.  Our nursing home litigation team is always available for consultation. (888) 424-5757

Related Nursing Homes Abuse Blog Entries:

Nursing Home Waits 19 Hours To Provide Medical Treatment To Resident Who Fractured Her Hip During Sabina Lift Transfer

Nursing Home Cited For Mistreatment Of Resident Following Investigation Of Resident's Fractured Neck

Faulty Handicapped Lift Blamed For Nursing Home Death

Improper Transfer Leads To Fall & Ultimately Death Of Rehab Patient

In the U.S., upon learning of a fall or other injury, the nursing home staff must conduct an assessment to ensure no injury was sustained.  In cases where there is an apparent injury, the staff physician should alerted immediately as to the incident.

Once a physical assessment has been completed, federal law requires nursing homes to provide pain medication to the resident as soon as feasible.  As recipients of Medicare funding (the overwhelming majority of nursing homes) must comply with F-Tag 309 pertaining to Quality of Care:

Each resident must receive and the facility shall provide the necessary care and services to attain or maintain the highest practiceable physical, mental and psychological well-being, in accordance with the comprehensive assessment and plan of care.

Although the above language can be generally interpreted to included pain management for nursing home patients, CMS has proposed interpretative guidelines that undeniably require nursing homes to provide sufficient pain management:

Recognition and Management of Pain

In order to help a resident attain or maintain his highest practiceable level of well-being and to prevent or manage pain, to the extent possible, the facility:

• Recognizes when the resident is experiencing pain and identified circumstances when pain can be anticipated;
• Evaluates the existing pain and cause, to the extent possible; and
• Manages or prevent pain to the extent possible, consistent with eh resident's goals, the comprehensive assessment and plan of care and current clinical standards of practice.

Unfortunately, many nursing home residents needlessly suffer from acute (falls) and chronic medical conditions (pressure sores) due to facilities failure to properly follow CMS regulations.  On the surface, this omission may simply be a violation-- but when a resident sits without medical attention with a broken hip or open wound these violations represent a complete lack of compassion and destruction of the quality of life.

Related Nursing Homes Abuse Articles

How Many Falls Is Enough To Impose Responsibility On Nursing Home?

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