Bill Myers from Provider Magazine had an interesting article about dementia and hip fractures. “A team of researchers crunched data on nearly 46,000 elders’ hip fractures in Ontario between 2003 and 2010 and found that people with dementia accounted for more than four-fifths of hip fractures in long term care centers and nearly one-quarter of hip fractures in the community. Several previous studies have shown that those with dementia who break their hip are more likely to die, and more quickly, than their peers.”
The findings were published in the latest edition of the Journal of the American Medical Directors Association. Researchers found further evidence that those with dementia “are a high-risk group who likely require specialized care processes” after surgery.
Falls during hospital stays injured or killed at least 92 patients in Washington state last year. Preventing falls is an important facet of care, especially for patients in high risk groups. Age can be a contributing factor as well as medications. For instance, patients who are given Ambien are four times more likely to suffer a fall, and Ambien is just one of over a dozen medications the FDA warns may cause sleep walking.
Some hospitals use fall alarms to let staff know when a patient has gotten out of bed, but they aren’t foolproof, and unless there is a staff member available to answer to the sound of the alarm they are useless. They also are a stressor for patients when they sound for extended periods of time. Patients will beg for the alarms to be turned off after they are triggered and not shut off by staff.
Nurses unions are pushing for legislation to force hospitals to increase staffing. This would increase the care given to patients and help reduce errors and accidents like patient falls. Hospitals are fighting back however, saying they can reduce errors without hiring more workers. Last year, the hospital with the worst record for falls was bought by new owners. The new owners increased staff by more than 100 individuals and overhauled their safety procedures. Their fall risk fell by two-thirds after this change in procedure. See article at NPR.
HealthDay News reported on a recent study that showed that 37% of falls in nursing homes result in head injury. The study was published Oct. 7 in the CMAJ (Canadian Medical Association Journal). People hit their head on the floor in 63 percent of such cases, most often striking hard flooring, such as tile or linoleum. Sixteen percent struck their head on furniture and 13 percent hit their head on a wall. The risk for head impact was much higher for forward falls than for backward falls, and attempts to use the arms to break falls were ineffective, according to a journal news release.
“Although we cannot identify why hand impact was generally ineffective in halting downward movement and preventing head impact, likely causes include ineffective arm placement; non-optimal muscle tone or muscle activation at impact; and insufficient strength in upper-limb, neck and trunk muscles, which is amenable to improvement through resistance training,” the researchers wrote.
Creating a safer environment is a suggestion — such as adding a flooring sub-layer that is soft enough to cushion the impact but not so soft that it impairs balance.
The U.S. National Institute on Aging has more about older adults and falls.
Two caretakers at the Bell Avenue Nursing Center in Elk City, OK have been charged in the death of a 76 yr old patient. Elisha Embley and Licilia Garcia were both charged for concealing a crime and conspiracy to conceal a crime. Embley has also been charged with second degree felony murder-neglect by a caretaker, abuse by a caretaker, and neglect by a caretaker. The 76 yr old was injured during a transfer from the bed to a wheelchair, resulting in life threatening injuries. The patient later died. See article here.
Jose Jorge Gonzales was allegedly dropped twice by staff at the New Orleans Home for the Incurables and is suing the home for neglect, pain and suffering, and medical expenses. Gonzales is a quadriplegic, and was dropped while he was being transferred to his wheelchair. The first fall, on August 25, 2011, resulted in a broken leg. On September 1, one week later, he was dropped again. That fall resulted in serious injury to his lower back and spinal area. The suit also claims that the home failed to provide a safe environment and maintain proper equipment.
See article at The Louisiana Record.
Maureen Flowers, a nursing home worker in NY faces charges of manslaughter and criminally negligent homicide in the death of Sinia Malone, 86. Her son, Rev. Lee Thompson, is advocating for more oversight in homes as a result of his mother’s death. Flowers attempted to lift Sinia without assistance from another staff person. She dropped Sinia, whereupon she left her bleeding and in need of assistance so she could go convince another staff person to lie about what happened. Sinia Malone died in February 2012 as a result of the incident. See AP article here.
Researchers at Carnegie Mellon University have developed a complex algorithm which could be used to help facilities monitor residents. The multi-camera, multi-object tracking system was tested in a nursing home. This system seemed destined to meet the same low percentage as other algorithms, as it has relatively few cameras, which was a problem for the other algorithms. To achieve comprehensive coverage of residents, it was thought that there had to be an extensive number of cameras, covering every hallway, and every area. However, this system utilizes the complex algorithm to render full camera coverage unnecessary.
Using the algorithm, this system can track residents to a meter of their actual location with an 88% success rate. The system, which could help facilities monitor residents for changes in activity and could help identify patterns indicating a mental status change, uses facial recognition to pinpoint residents. The system isn’t perfect, as the researchers are looking for ways to increase privacy protection, but it is a step forward in the journey for an indoor monitoring system. The researchers will present their findings June 27 at the Computer Vision and Pattern Recognition Conference in Portland, OR.
See full article at Mcknight’s.
With Baby Boomers growing older, nursing homes, assisted living facilities and retirement communities are racing to find ways to manage the increase they’re already seeing. To keep up with the growing number of residents, some nursing homes, like Spring Hills Somerset in New Jersey, have installed ‘smart sensors.’ These so called ‘smart sensors’ are really a complex system of motion sensors and detectors. At Spring Hills, they’ve been placed under beds, in the rooms and in the showers in an effort to help nurses and the facility monitor the activity of its dementia patients.
The data is sent to the nurses at the facility, and a red dot is placed by the names of those whose daily activities have changed. This system alerted the nurses in the facility that a normally active patient was lying in bed most of the day. She was developing pneumonia. Since the nurses were alerted to her behavior change, they monitored her more closely and were able to treat the pneumonia while it was still early.
Given its success, this technology may seem like a boon, especially considering the influx of patients facilities are expected to get in the next twenty years. But nursing home funding has been cut nationwide, leaving a gap between the demand for those services and the amount of funding available to keep facilities operating. With the number of potential residents increasing and the amount of funding decreasing, this technology, which could be potentially lifesaving, is reserved for those facilities lucky enough to receive federal and private grants.
See article at Valley News.
Market Watch reported that EarlySense, the market leader in Proactive Patient Care Solutions™, announced the results of a multi-center clinical study demonstrating that the EarlySense system helps medical teams at rehabilitation centers to reduce patient falls as well as the number of patients transferred back to the hospital. The clinical data was collected from The Hebrew Home at Riverdale, NY and Dorot Medical Center in Israel. The data was presented today at the 2013 Annual Scientific Meeting of the American Geriatrics Society (AGS) by Hebrew Home medical director and study principal investigator Dr. Zachary J. Palace in a poster titled The Effect of a Continuous Patient Monitoring System on Reducing Hospitalization and Falls in Skilled Nursing Facilities. For additional information, please visit http://www.earlysense.com.
Dr. Palace said, “The implementation of EarlySense on the post-acute care units has demonstrated a significant decrease in the total number of falls and a trend towards reduction in the readmission rate back to hospitals, thus improving the overall quality of care for the elderly. The system also alerted regarding early warning signs of patient deterioration which enabled our medical team to proactively respond and literally save four lives. As clinicians we are always on the lookout for better ways to provide safer, more effective care for our patients.”
Dr. Palace continued, “Patient falls and subsequent hospital transfers are an ongoing challenge for most rehabilitation centers. The EarlySense system is the first technology to help us more effectively and proactively respond to early warning signs of deterioration and potential falls to secure better patient outcomes. We’ve experienced success and look forward to continuing this trend.”
Dorot Medical Center principal investigator Dr. Gad Mendelson said, “As the population ages, we are seeing a growing need to provide safer, smarter care without increasing our staffing level. In this clinical trial, we saw that the continuous monitoring nature of the EarlySense system and its low level of false alarms allowed our team to reach deteriorating patients earlier without creating alarm fatigue.”
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Alarms to prevent falls is standard in the nursing home industry since the federal government limited the use of physical restraints in the early 1990s. Many nursing homes rely on alarms to warn them if a resident who is at risk for falls is getting up. However, a new trend is emerging for alarm free facilities. Many nursing homes now claim that alarms are not effective to prevent falls. A study last year in the Annals of Internal Medicine that was based at a Tennessee hospital found that alarms did not statistically reduce fall rates. The most effective safety measure is adequate staffing and supervision. Connecticut’s The Day had an interesting article on this controversial issue.
“Kimberly Hall South is among a handful of nursing homes in Connecticut that have gone “alarm-free,” meaning residents at risk of injury, usually from falls, are no longer outfitted with detectors on their mattresses, chair pads and clothing that emit a warning signal when they try to get up and move around.”
Most experts say alarms are an important fall-prevention measure, especially for residents with dementia or poor safety awareness who may try to get out of bed at night unsupervised. The alarms remind the residents that they should not move, while also summoning staff to assist. Nursing staff must be more diligent in monitoring patients but the lack of noisy alarms lowers anxiety for residents, especially those with cognitive problems, and improves the quality of thier life.
According to data from the U.S. Centers for Disease Control and Prevention, about 1,800 elderly nursing home residents die each year from injuries sustained in falls. Thousands more suffer serious injuries, such as broken hips. In Connecticut, nursing homes overall report that 3.1 percent of long-stay residents experience one or more falls with major injury, slightly lower than the national average.
Other preventative measures include frequent checks on residents who are at risk of falls; additional staffing, safety vests, lap cushions, siderails, hip protectors, detailed assessments of residents’ needs, to identify when and why they get up and try to walk, including their toileting needs; and consistent assignments of nursing staff to particular patients.
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