Authorities are investigating the death of 45-year-old James Hussien who died in a fall from a second-floor window of the Hunt Nursing & Rehabilitation Center. Peter Roberts, administrator of the nursing home, said in a prepared statement that the man’s body was found on the ground beneath his second-story window at approximately 3:40 p.m.
A new study led by a Johns Hopkins researcher suggests that hearing loss may be a risk factor for falls. The finding could help researchers develop new ways to prevent falls, especially in the elderly, and the resulting injuries, which generate billions in health care costs in the United States each year (Archives of Internal Medicine, 172: 369-71). To determine whether hearing loss and falling were connected, Frank Lin, MD, PhD, of Johns Hopkins, and Luigi Ferrucci, MD, PhD, of the National Institute on Aging, used data from the 2001 to 2004 cycles of the National Health and Nutrition Examination Survey, which periodically has gathered health data from thousands of Americans since 1971.
The study found that people with a mild hearing loss (25 dB) were nearly three times more likely to have a history of falling. Every additional 10 dB of hearing loss increased the chances of falling by 1.4. Even excluding participants with moderate to severe hearing loss from the analysis didn't change the results. This finding held true even when researchers accounted for other factors linked with falling, including age, gender, race, cardiovascular disease and vestibular function.
The Grand Rapids Press had a story about the tragic incident involving Matthew Ambrose. On Sept. 12, Matthew Ambrose perched at the edge of his bed at the Grand Rapids Home for Veterans. Staff knew Ambrose was a high risk for falls because he suffers from Alzheimer's disease, has a poor sense of balance and could not be left unattended when he was in a position where he could fall.
A privately contracted nurses aide sat the World War II veteran on the side of his bed and left the room to retrieve a lift apparatus to transport him from his bed into a wheelchair. When she returned, Ambrose was on the floor with his neck broken. "The Ambrose lawsuit claims the contracted nurses aide should have known Ambrose was a risk to leave alone. According to the suit, Ambrose has dementia, Parkinson's disease and "a history of falling," worsened by prescription medications that make him "even more prone to falling." Ambrose now resides in a Grand Rapids nursing home, where Eskola visits him virtually every day. After his fall, Eskola said, her father had surgery at Metro Health Hospital in which a surgeon inserted a metal screw to stabilize a neck bone broken by the fall."
His daughter, Janice Eskola, believes her father's fall represents more than one unfortunate incident at the home. It is about putting budget priorities ahead of the welfare of men and women who served their country. "State officials insist budget pressures afford them little choice but to trim expenses because of a $4.2 million cut in state funds to the home and stalled plans to replace 170 union nurses aides with non-union contract workers. "
Gov. Rick Snyder intends to extend privatization in the 2012 budget for the home, at an estimated savings of up to $5.8 million a year. State funds to the home were cut by $4.2 million in anticipation of that move.
McKnight's had an article on a study that concluded many elderly nursing home residents are not getting enough Vitamin D. Vitamin D deficiency can contribute to higher rates of falls and fractures in the elderly due to its effects on calcium absorption and bone metabolism. Physicians advise that those over the age of 70 should take in 800 international units of vitamin D per day
The German study showed nearly all residents had insufficient levels of vitamin D, while more than two-thirds had severely deficient levels.
Nursing home residents with dementia who use average doses of selective serotonin reuptake inhibitors (SSRIs) are three times more likely to have an injurious fall than similar people who don't use these drugs. The association can be seen in people who use low doses of SSRIs and the risk increases as people take higher doses. The results are published in the British Journal of Clinical Pharmacology. Falls are a major health problem in nursing home residents with dementia. In nursing homes one-third of all falls result in an injury.
Many nursing home residents with dementia are treated with antidepressants. Selective serotonin reuptake inhibitors (SSRIs) are generally considered the treatment of choice. "Our study also discovered that the risk of an injurious fall increased even more if the residents were also given hypnotic or sedative drugs as sleeping pills," said lead author Carolyn Shanty Sterke, who works in the Section of Geriatric Medicine at Erasmus University Medical Center, Rotterdam, The Netherlands. "Physicians should be cautious in prescribing SSRIs to older people with dementia, even at low doses," says Sterke.
The incident reports showed that 152 of the 248 residents (61.5%) sustained 683 falls. This corresponds to a fall incidence of 2.9 falls per person-year. Thirty-eight residents had a single fall, but 114 fell frequently. Two hundred twenty falls resulted in injury or death. Of these 10 were hip fractures, 11 were other fractures and 198 were injuries such as grazes, open wounds, sprains, bruises, and swellings. One person died after falling.
"Staff in residential homes are always concerned about reducing the chance of people falling and I think we should consider developing new treatment protocols that take into account the increased risk of falling that occurs when you give people SSRIs," says Sterke.
See also story at USAToday.
More information: Dose-response relationship between Selective Serotonin Reuptake Inhibitors and Injurious falls: A study in Nursing Home Residents with Dementia. Carolyn S Sterke, Gijsbertus Ziere, Ed F. van Beeck, Caspar W. N. Looman & Tischa J. M. van der Cammen. BJCP (2012); DOI: 10.1111/j.1365-2125.2011.04124.x
The Daily Pilot reported that the Newport Nursing and Rehabilitation center is fighting a $100,000 fine that the California Department of Public Health has issued after a woman died on September 6, 2011 because of a preventable fall after she was left alone and unsupervised in the bathroom. Several nurses noted that the woman needed constant supervision.
The Department of Public Health found that the nursing home failed to properly supervise the woman causing the fall. The nurse who was responsible for supervising the resident in the bathroom left her alone to go take a break. Why wouldn't she wait to take her break? Where was the charge nurse?
Another employee of the nursing home found the woman face down on the floor. Medics were able to briefly revive her but she remained brain dead and had a fractured spine.
A press release published by Wiley-Blackwell on a new study discussing the benefits of physical therpay after hip surgery. Researchers studied the results of patients who receive walking skills training following hip arthroplasty which showed increased mobility. This study was published in the journal: Arthritis Care & Research. “The World Health Organization (WHO) estimates that 10% of men and 18% of women 60 years of age and older suffer from osteoarthritis. In the U.S., the National Hospital Discharge Survey reported that 230,000 Americans had hip replacement surgery in 2007.”
Past studies reported patients desired pain relief and ability to move through daily functions and a normal lifestyle. But improvements in pain and mobility were only temporary after surgery as people with hip replacements had more difficulty walking than healthier peers, they also experienced more pain. Physical therapy was a major component being left out.
The study was conducted to see the effects of the walking skills therapy, and results show those who took part in the program had increased mobility and less pain. "The training program was well tolerated by patients and no complications were reports,” concludes Ms. Heiberg. “Our findings suggest physical rehabilitation helps improve mobility and function in patients who received hip replacements.”
Connecticut Law Tribune had an interesting article on the problem of falls in nursing homes. When the elderly fall, they usually end up breaking bones, fracturing hips and even sustaining head injuries due to the frail nature of their bones. These injuries are often fatal. According to the American Academy of Orthopaedic Surgeons, there are about 380,000 hip fracture cases annually. Many of these falls occur in nursing home facilities where the elderly should be monitored and carefully watched.
Nursing homes are expected to provide adequate care for elderly residents living in their facilities. Federal law mandates that nursing homes ensure that their facilities are “free of accident hazards as is possible; and that each resident receives adequate supervision and assistance devices to prevent accidents.” To prevent falls, nursing home residents must be fully assessed by a qualified staff member. A registered nurse or physician should conduct proper and periodic monitoring for all residents to determine their risks for falling. If a resident is at high risk of falling, which most are, special accommodations and closer monitoring are required.
A variety of state and federal laws govern such facilities, including 42 CFR 483.1-483.75 (Requirements for Long Term Care Facilities); and various sections of the Social Security Act, 42 U.S.C §1302, §1395i-3(a)-(f), §1395x(j) and (l), §1395z, §1395hh, §1396a(a)(28), §1396d(a),(c), and (d) and §1396r(a)-(f) (Nursing Home Reform Act of 1987).
Yet, despite the safeguards in place, many seniors still experience preventable falls. Experts point to a number of reasons includiing: residents are not properly assessed by a qualified staff member; residents are simply left unattended and unsupervised; facilities fail to adequately equip residents’ beds with safety devices such as bed rails or lowering the bed closer to the floor; fail to install proper alarm systems or overlook the need for crash mats if slippery floors are present.
Fox40 reported the fine levied against Crystal Ridge Care Center. Crystal Ridge received a Class AA citation from the California Department of Public Health and faces a $75,000 fine for failing to ensure a resident remained free of injury. In February, a certified nursing assistant transferred a resident by herself out of a bathtub using a mechanical lift. Two people are required when using the lift.
According to the investigation by the CDPH, the male resident fell out of the chair and broke his neck and injured his head. The man died four days later.
During the investigation, the Director of Staff Development said they had not done any lift training for the nurses, and the Administrator admitted the facility does not verify the competencies of the nursing staff. The CDPH found Crystal Ridge failed to ensure the man’s safety by their nurse incorrectly using equipment.
Nursing home residents taking antidepressant medications are at an increased risk of falling in the days following the start of a new prescription or a dose increase of their current drug, according to a new study by the Institute for Aging Research of Hebrew SeniorLife, an affiliate of Harvard Medical School. The side effects of Wellbutrin, Zyban, Effexor and similar drugs increase the risk of nursing home falls.
Published online in the Journal of Gerontology: Medical Sciences, the study found that nursing home residents have a fivefold increased risk of falling within two days of a new prescription for or an increased dose of a non-SSRI (selective serotonin reuptake inhibitor) antidepressant such as bupropion or venlafaxine. Nursing home staff must closely monitor these residents following a prescription change to prevent potential falls.
To reduce the risk of nursing home falls and other injuries, all facilities are required to have an assessment done when a resident enters the facility. The assessment should describe the functional capacity of the resident and evaluate their risk for falling. Based on this assessment, proper steps must be taken to supervise the resident and provide safety devices to prevent a fall injury.
The study looked at data on 1,181 nursing home residents who suffered falls, and researchers found that nursing home residents were nearly five times as likely to fall within two days of being put on a new non-SSRI antidepressant than those who were not given the drugs. The average age of those who fell was 88 and 71% were female. The effect decreased with time and after five days of being on the antidepressant the risk of falling equaled those of other nursing home residents, researchers found.
Lead author Sarah D. Berry, M.D., M.P.H., a scientist at the Institute for Aging Research, says the risk of falls may be due to acute cognitive or motor effects that have not yet been fully investigated. Certain non-SSRIs, such as trazodone, can cause postural hypotension, a dramatic decrease in blood pressure upon standing that may contribute to falls. Other non-SSRIs, like venlafaxine, can cause sedation and coordination problems that may lead to falls.
According to some estimates, more than one-third of the country's nearly 1.6 million nursing home residents take some type of antidepressant medication. Several previous studies have implicated antidepressants, including both SSRIs, such as paroxetine and sertraline, and non-SSRIs, as a risk factor for falls, especially among older adults.
Both tricyclic antidepressants and SSRIs, the most commonly prescribed antidepressant medications, have been associated with up to a sixfold increased risk of falls among nursing home residents in other studies. Newer drugs, including serotonin-norepinephrine reuptake inhibitors, may also be associated with falls risk.
In light of her findings, says Dr. Berry, an instructor in medicine at Harvard Medical School, "nursing home staff should keep a watchful eye on residents in the days following a non-SSRI antidepressant change to prevent falls and clinicians should avoid making changes on weekends or during times when unfamiliar staff is present."
The study was funded by a grant from the National Institute on Aging, the Hartford Geriatrics Health Outcomes Research Scholars Awards Program, and the Men's Associates of Hebrew SeniorLife.
Scientists at the Institute for Aging Research seek to transform the human experience of aging by conducting research that will ensure a life of health, dignity and productivity into advanced age. The Institute carries out rigorous studies that discover the mechanisms of age-related disease and disability; lead to the prevention, treatment and cure of disease; advance the standard of care for older people; and inform public decision-making.
Founded in 1903, Hebrew SeniorLife, an affiliate of Harvard Medical School, is a nonprofit, nonsectarian organization devoted to innovative research, health care, education and housing that improves the lives of seniors. For more information, please visit www.hebrewseniorlife.org.
Enter keywords:
