Nursing Home Deaths

Statistics

About 150 nursing homes exists in Egypt, housing 3000 patients.

Approximately 17, 000 nursing homes exist in the U.S., housing 1.5 million patients
over the age of 65 years.

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 Causes!
Deaths in Nursing Homes (NH) are, for the most part,

natural and usually do not fall under the medical

examiner’s jurisdiction.

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There are exceptions, such as:

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 1.
Drug Overdoses
● Mood: inadvertent or intentional.
● Way: too much medication or the wrong medication.
● Death is uncommon in these situations.
● When death does occur, the nursing home is probably often
unaware of the mix-up and assumes the death to be natural.
● Example of each.

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 2.
Accidents Not
Involving Medications
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These include:
● asphyxial deaths caused by bedrails and restraint vests.
● drinking of cleaning fluids by senile patients.
● burns caused by immersion in hot bath water.
● falls.

- It is not uncommon for the NH staff to attempt to conceal a fatal

accident.

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 3. Homicides
The perpetrators of the homicides may be:
● NH personnel.
● visiting family members.
● fellow patients.

- Example: patients were beaten to death by fellow patients who suffered from
Alzheimer’s disease. Weapons used were a metal crutch and part of a wheelchair.

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4. Suicides
- These are very uncommon.
- More common are the spouses of
patients with chronic or fatal disease
who come in, kill the patient, and then
kill themselves.

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 5.
Gross Neglect of Patients

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● Nursing homes or personnel have been charged with homicide
for improper and inadequate care of patients.

● Example: In one case involving a death resulting from infected

decubitus ulcers (pressure sores), the care-home provider was
convicted of manslaughter.

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 Signs of neglect

● Contractures

● Malnutrition

● Dehydration

● Decubitus ulcers

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 The biggest problem in NHs
● Unskilled staff.
● Employees may not be adequately screened.
● Training is minimal.
Documentation:
● Records will show that all food is eaten, but severe weight loss and malnutrition
ensue.
● Records will show that patients are turned every 2 h, but decubitus ulcers develop.
● Medications are always given, even when it turns out that they were not available.
● In some instances, care is documented as being given even after the patient has
died.

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Contractures

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 Definition:
A contracture is an abnormal, often permanent, condition characterized by
flexion and fixation of a limb at a joint. Contractures leave the joint in a non-
functional position, resistant to bending. They are caused by atrophy and
abnormal shortening of muscle fibers.

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 Mechanism:
● The primary cause is disuse.
● Prolonged bed rest, even in “normal” individuals, results in loss of lean
muscle mass through lack of use.
● The muscles become weak, atrophic, change shape, and shorten with
disuse.
● The muscle decreases in diameter and in the number of muscle cells.
● Eventually, there may be replacement with fibrous connective tissue,
progressing to fibrosis and development of contractures.
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 IN NHs
● Contractures are seen in NH patients with impaired sensorium who are
confined to bed.
● In such patients, a nurse should administer a passive range of-motion
exercises on a daily basis to prevent development of contractures.
● Often, this is not done and contractures develop.
● Development of contractures indicates poor nursing care i.e., that the
individual is not receiving appropriate joint exercises.
● Approximately 20% of nursing home residents nationwide have
contractures.
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Malnutrition

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● Malnutrition is manifested by a deficit, excess, or imbalance in
essential components of a balanced diet.
● The type of malnutrition seen in nursing homes is usually protein-
caloric malnutrition.
● Thirty-five to 80 percent of patients in nursing homes are
malnourished, with 30–40% of patients substandard in weight.

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 Malnutrition in nursing home patients can be caused by:
● Chronic disease conditions that make eating difficult, e.g.,
paralysis caused by a stroke
● Increased caloric or protein requirements due to infection or the
healing of wounds
● Medications that impair the desire to eat, e.g., psychotropic drugs
● Failure of the nursing home to feed the patients

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 Cycle

● Malnutrition predisposes an individual to the development of

decubitus ulcers and infection. These, in turn, lead to increased
caloric and protein requirements, thus making the malnutrition
worse, which, again, predisposes to decubitus ulcers and
infection.

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 Indicator of malnutrition

● Loss of weight.
● Low levels of albumin reflect longstanding malnutrition. (half-life of
albumin is 12 to 20 d).
● In contrast, acute starvation reduces the concentrations of proteins
that have a short half-life: transferrin (half-life 5 d) and prealbumin
(half-life 2 d).

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Dehydration

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 Causes of dehydration
● Dehydration is very common in NH patients.
● It is caused by:

○ illness (diarrhea, fever, infection).

○ the effects of medications (e.g., diuretics).

○ Decreased fluid intake.

● When personnel do not monitor the intake of fluid and provide extra
fluids when required, dehydration develops.
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Decubitus Ulcers

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 Factors predisposing to pressure sores are:

● Depressed sensory or motor function

● Altered consciousness
● Pressure over bony prominences
● Malnutrition
● Shearing forces
● Moisture (fecal and urinary incontinence)

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Stages of decubitus ulcers

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 Preventive measures
● In bed, the patient should be turned or repositioned at least every 2 h.
● Adequate nutrition and hydration should be given.
● the skin must be kept dry by preventing patients from lying in their
urine and feces.
● the head of the bed should not be raised to such a degree that the
patient will slide down and, if necessary, extra padding over bony
prominences should be provided.
● If a sore develops, the physician should be notified immediately.

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Thank you