Seniors who are taking antidepressants, sedatives, and other psychotropic medications may be at an increased risk for falls, according to a new study published in the November 23, 2009 issue of the Archives of Internal Medicine.

Canadian researchers analyzed 22 published studies, which included a total of 79,081 participants older than 60. The studies evaluated the effects of 9 classes of drugs:

• High Blood Pressure Medicines
• Diuretics
• Beta Blockers
• Sedatives and Hypnotics
• Neuroleptics and Antipsychotics
• Antidepressants
• Benzodiazepines
• Narcotics
• Non-Steroidal Anti-Inflammatories

After reviewing the data and other factors, the researchers concluded that there was a significant association between older adults’ use of sedatives, hypnotics, antidepressants and benzodiazepines, and their risk of falls.

“Given the divergent results shown by some observational assessments within specific medication classes, the results of our meta-analysis reiterate the need for caution when prescribing these medications to seniors,” wrote John C. Woolcott, of the University of British Columbia and the Centre for Health Evaluation and Outcomes Sciences in Vancouver, and his colleagues.

“It is hoped that future research in this area can be completed with larger sample sizes in both community and long-term care facility settings and thus improve the quality of information about fall risks that is available to physicians and pharmacists when they are deciding which types of pharmacotherapy to provide,” the researchers added.

Over 30 percent of people who are 65 years or older will suffer a fall at least once a year. Falls and their complications are the fifth leading cause of death in the world.

However, falls and fractures are not an inevitable part of growing older. In fact, many can be prevented. To reduce your risk of falls and fractures, you can:

• Make personal lifestyle changes to increase your physical well-being.
• Make changes in your home.
• Consider using walking aids or other assistive devices.
• Take steps to maintain or improve your bone health.
• Talk to your doctor about other steps you can take to lower your risk of falling.

The Sam Bernstein Law Firm encourages all consumers to stay informed of current medication news, to ensure the safety of you and your family.

In addition to federal government oversight, the State of Michigan regulates the quality of care in nursing homes. The Patient’s Bill of Rights in the Michigan Public Health Code, MCL 333.20201, includes the following protections:

* A Michigan patient or resident is entitled to be free from mental and physical abuse and, except as authorized by a physician, or as necessitated by an emergency to protect the patient, free from physical and chemical restraints.
* A Michigan patient or resident shall not be denied appropriate care based on race, religion, national origin, sex, age, handicap, marital status, sexual preference, or source of payment.
* An individual may obtain a copy of, or inspect his/her medical records, and a third party shall not be given a copy without authorization of the patient except as required by law and third party contract.
* A Michigan patient or resident is entitled to privacy, to the extent feasible, in treatment and caring for personal needs with consideration, respect, and full recognition of his/her dignity and individuality.
* A Michigan patient or resident is entitled to receive adequate and appropriate care and information about his/her medical condition, proposed treatment and prospects for recovery, unless medically contraindicated by the physician in the medical record.
* A Michigan patient or resident is entitled to receive and examine an explanation of his/her bill. He/she also is entitled to know who is responsible for, and who is providing, his/her care.
* A Michigan patient or resident is entitled to associate and have private communication with his/her physician, attorney or any other person, and to send and receive personal mail unopened, unless medically contraindicated.
* A Michigan patient’s civil and religious liberties shall not be infringed. The nursing home shall encourage and assist in the exercise of these rights.
* A Michigan patient or resident is entitled to retain and use personal clothing and possessions as space permits. At the request of a patient, a nursing home shall provide for safekeeping of personal property and funds, except that a nursing home shall not be required to provide for the safekeeping of property, which would impose an unreasonable burden on the nursing home.
* Each Michigan nursing home patient shall be provided with meals that meet the recommended dietary allowances for the patient’s age and sex and that conform to the individual’s special dietary needs.
* A Michigan nursing home, its owner, administrator, employee, or representative shall not discharge, harass, retaliate, or discriminate against a patient because a patient has exercised rights protected by law.

If you think that a loved one was the victim of nursing home abuse or neglect, you owe it to that individual and your family to try to find out what happened. It is important to talk with a Michigan Attorney experienced in nursing home cases and Michigan regulations of nursing homes.

Both federal and state laws regulate almost every aspect of nursing home activity. If a patient is abused or neglected, the nursing home probably is violating the strict laws prohibiting improper treatment.

The following are some of the specific sections of the Code of Federal Regulations (CFR), which regulate the nursing home industry:

• Care for its residents in a manner and in an environment that promotes maintenance or enhancement of each resident’s quality of life (42 CFR 483.15).
• Promote care for residents in a manner and in an environment that maintains or enhances each resident’s dignity and respect in full recognition of his or her individuality (42 CFR 483.15).
• Ensure that the resident has the right to choose activities, schedules, and health care consistent with his or her interests, assessments, and plan of care (42 CFR 483.15).
• Conduct initially (no later than 14 days after admission) and periodically (after a significant change in the resident’s physical or mental condition and, in no case, less often than once every 12 months) a comprehensive, accurate, standardized, reproducible assessment of each resident’s functional capacity (42 CFR 483.20).
• Develop a comprehensive care plan for each resident that includes measurable objectives and timetables to meet the medical, nursing, mental, and psychosocial needs identified in the comprehensive assessment. The care plan must be developed within 7 days after completion of the comprehensive assessment and describe the services that are to be furnished. In addition, qualified persons must review, and if necessary revise, the care plan prepared after each assessment (42 CFR 483.20).
• Prevent the deterioration of a resident’s ability to bathe, dress, groom, transfer and ambulate, toilet, eat, and to use speech, language or other functional communication systems (42 CFR 483.25).
• Provide, if a resident is unable to carry out activities of daily living, the necessary services to maintain good nutrition, grooming, and personal and oral hygiene (42 CFR 483.25).
• Ensure that residents receive proper treatment and assistive devices to maintain vision and hearing abilities (42 CFR 483.25).
• Ensure that residents do not develop pressure sores and, if a resident has pressure sores, must provide the necessary treatment and services to promote healing, prevent infection and prevent new sores from developing (42 CFR 483.25).
• Provide appropriate treatment and services to incontinent residents to restore as much normal bladder functioning as possible and prevent urinary tract infections and to restore as much normal bladder function as possible (42 CFR 483.25).
• Ensure that the resident receives adequate supervision and assistive devices to prevent accidents (42 CFR 483.25).
• Ensure that a resident maintains acceptable parameters of nutritional status, such as body weight and protein levels (42 CFR 483.25).
• Provide each resident with sufficient fluid intake to maintain proper hydration and health (42 CFR 483.25).
• Ensure that residents are free of any significant medication errors (42 CFR 483.25).
• Maintain sufficient nursing staff to provide nursing and related services to attain or maintain the highest practicable physical, mental, and psycho-social well-being of each resident, as determined by resident assessments and individual plans of care (42 CFR 483.30).
• Ensure that the medical care of each resident is supervised by a physician and must provide or arrange for the provision of physician services 24 hours a day, in case of an emergency (42 CFR 483.40).
• Provide pharmaceutical services (including procedures that assure the accurate acquiring, receiving, dispensing, and administering of all prescriptions) to meet the needs of each resident (42 CFR 483.60).
• Be administered in a manner that enables it to use its resources effectively and efficiently to attain or maintain the highest practicable physical, mental, and psychosocial well-being of each resident (42 CFR 483.75).
• Maintain clinical records on each resident in accordance with accepted professional standards and practices that are complete, accurately documented, readily accessible, and systematically organized (42 CFR 483.75).

If you think that a loved one was the victim of nursing home abuse or neglect, you owe it to that individual and your family to try to find out what happened. It is important to talk with a lawyer experienced in nursing home cases and federal regulations of nursing homes.

Even at a well-known, fully licensed nursing home, there is the possibility of abuse or neglect. That is why you need to make sure that a facility will provide your loved one with quality care.

Touring a facility is only the first step, because a scheduled visit is unlikely to reveal everything that is happening beneath the surface or when no one is visiting. Certainly, your goal is to assure quality care for your loved one, as well as peace of mind for your family. To accomplish this, it’s helpful for you to take the following steps before selecting a nursing home:

• Talk with other residents at the nursing home that you are considering. You can simply walk the corridors of the facility, and speak with residents, including those who are bedridden.
• In addition, your own physical observations are extremely important. Do the residents appear well groomed? Do any of them have visible wounds or sores? How is their oral care? If you find several residents who seem confused and disoriented, you may be witnessing signs of neglect.
• Federal regulations require that all nursing homes have the latest state survey of the facility readily available for review. Ask the management for this survey, read it carefully, and ask questions. Be on the lookout for signs of any problems with basic care.
• Ask questions about the staff at the facility. What is the size of the staff during the different hours of the day and night? How many staff members are nurses? How many are nursing assistants? Are there social workers and clergy on the staff? Consider how the staffing of that facility compares to other nursing homes with a similar number of patients.
• Speak with the relatives of other residents at the facility. Have they observed any problems? Do they have any issues with the management or staff at the facility? You may wish to find out whether any of the residents’ families use of web cameras (sometimes called "granny cams"). Although this cyber visitation is a new practice, some families who cannot visit their loved ones every day are placing special internet cameras in relatives’ rooms to allow them to see what is happening at any time. If you see a "granny cam" at a facility, ask to speak with the family of that resident, to learn what they have observed. If possible, inquire if the facility would mind if you used this kind of device.
• When walking the halls of the facility, use your senses. One of the most effective methods of inspecting a facility may be your sense of smell. A nursing home should not smell of urine or feces. If it does smell, residents may not be receiving adequate toileting care. Often, this basic care is essential to preventing life-threatening illnesses, like urinary tract infections or bedsores.
• Watch as residents are being fed. Do many residents look underweight? How much of the food are they eating? Is staff helping residents who have problems feeding themselves? Do the aides who assist with the food seem overwhelmed? Are the aides spending enough time working with each resident during mealtime?
• If at all possible, visit the potential nursing home more that once and plan your visits at different times of the day and week. If you can only visit the nursing home once, go at night or on a weekend afternoon. Staff levels may be lowest during these "off" times.
• Is water easily available to all residents at the facility? If some residents are incapable of helping themselves to a drink, is staff offering assistance at regular intervals?
• When you attempt to look at the facility, are you deliberately steered to certain rooms or residents? If you feel that you are being denied full access to the facility, you should find out if there is a good reason.
• Ask to meet all of the key executive personnel at the facility. Speak with the administrative head, the medical staff administrator, and the nursing staff administrator. Ask how often physicians actually examine residents. Find out about the facility’s staff turnover rate, including the average length of employment for nursing assistants and other primary caregivers.

Nursing Home Evaluation Checklist

You should be alert whenever you visit your loved one’s nursing home. The following are questions to ask yourself during each visit:

• Do you notice signs that your loved one is suffering from dehydration (lack of water) or malnutrition (lack of food)?
• Have you noticed the resident is less active or less able to move about?
• Have you noticed emotional changes, mood swings, withdrawal, anxiety, or other fears?
• Are residents dressed appropriately for the season and time of day?
• Are the resident’s living quarters clean?
• Are the resident’s medical conditions being treated in a timely manner?
• Does the resident seem to suffer from chronic viruses and/or infections?
• Are all medications administered in a timely and appropriate fashion?
• Has the nursing home staff delayed reporting an injury or incident to a doctor or to the resident’s family or guardian?
• Has the resident suffered frequent falls or broken bones?
• Does there seem to be adequate staff and supervision?
• Are the caregivers ignoring the resident or describing him or her as a burden?
• Does any caregiver react defensively to routine questions about the resident’s care?

Nursing homes must provide good nutrition and hydration to residents. Poor diet and lack of water are among the most common forms of nursing home abuse and neglect. Some of the health problems associated with malnutrition and/or dehydration include:

• Increased risk of infections
• Confusion
• Muscle weakness (possible immobility and increased risk of falls)
• Pressure ulcers or bedsores
• Pneumonia
• Increased risk of becoming ill from exposure to bacteria or viruses

The Importance of Proper Nutrition and Hydration

Nursing homes should conduct regular nutritional assessments and provide residents with well-balanced, palatable meals. When you consider a nursing home for a loved one, you may wish to ask to sample a random meal at the facility. Also, ask to speak to the staff dietitian about the factors they use to develop meal plans for the facility. The following is a list of reasons why an individual may suffer from malnutrition and/or dehydration:

Personal causes of malnutrition:

• Illness
• Adverse drug effects such as nausea, vomiting, diarrhea, cognitive disturbances, or sleepiness
• Food and drug interactions that decrease the ability of the body to absorb vitamins and minerals
• Depression
• Swallowing disorders
• Mouth problems such as tooth loss, dentures that do not fit properly, mouth sores, and mouth pain
• Tremors or shakiness, which affect residents’ ability to feed themselves

Environmental causes of malnutrition:

• Inadequate staff attention for residents who need help to eat
• Staff who lack training about malnutrition and the proper ways to feed residents who need help
• Reliance on liquid supplements
• Special diets

Signs that a resident is malnourished:

• Clothes fitting more loosely than usual
• Cracks around the mouth
• Pale looking lips or mouth
• Dentures that no longer fit
• Hair thinning or getting sparser
• Wounds that take longer to heal
• Confusion (which is unusual for that individual)
• Skin breaking down
• Sunken eyes
• Weight loss

The following questions may help you pinpoint the reason for a particular person’s problems with nutrition or hydration:

• Can the resident feed him/herself?
• What is the resident’s favorite meal of the day
• When and where does the resident prefer to have meals serve
• Does it take a long time for the resident to eat?
• Is the resident rushed through meals?
• Is the resident unable to finish meals?
• Does the resident seem to eat more when someone is there to help with the meal?
• Does the resident seem uninterested in food?
• Has the resident lost his/her appetite?
• Does the resident like the food at the facility?
• Can the resident choose from a menu?
• Are snacks readily available to the resident?
• Is the resident on a special diet?
• Has the resident started taking any new medications?
• Is the resident’s weight monitored on a regular basis?
• Has the staff informed family members of weight loss?
• Has staff asked family members for assistance?

Nursing home neglect and abuse is a national disgrace. In fact, this is a widespread — and increasing — problem in the United States. An analysis of the death certificates of persons who died in California nursing homes between 1986 and 1993 revealed that over 7%, or 1 in 15, of the deaths of seniors in nursing homes, resulted at least in part, to utter neglect, lack of food or water, untreated bedsores, or other generally preventable ailments. Since that study, this nation’s nursing home population has risen sharply. If the 1.6 million Americans now in nursing homes are dying of questionable causes at the same rate, then every year about 35,000 elderly citizens die prematurely or in unnecessary pain, or both. According to a survey published in the Journal of the American Geriatrics Society, 30% of those polled said they would rather perish than live in a nursing home.

The U.S. Congress and state legislatures have taken steps to make nursing homes accountable. The federal Nursing Home Reform Act states that a nursing home must provide "services and activities to attain or maintain the highest practicable physical, mental, and psycho-social well-being of each resident in accordance with a written plan of care." However, you still need to be alert to your own loved one’s needs, and if necessary, demand that the nursing home respect all of his or her legal rights. Listed below are examples of positive steps you can take to prevent problems and ensure proper treatment in a nursing home for your relative or friend.

Signs of Nursing Home Abuse

It is important to watch for signs that your loved one may be a victim of abuse or neglect. Most nursing home residents must depend on the staff for most or all of their daily needs, including food, water, medicine, toileting, grooming, stimulation and turning.

Although most facilities provide good care, some cause needless suffering and death. Sadly, many nursing home residents are starved, dehydrated, over-medicated, and suffer painful pressure sores. In addition, they may be isolated, ignored, and deprived of social contact and stimulation.

The following is a list of some forms of nursing home abuse:

• Assault and battery
• Sexual assault and battery
• Rape
• Unreasonable physical constraint
• Prolonged deprivation of food or water
• Use of physical restraints, like straps or bels
• Use of chemical restraints, like sedatives or sleeping medications
• Use of psychotropic or other medications for any purpose not authorized by a physician
• Excessive dosages of medication
• Withholding needed medication
• Confinement to a room or fixed location

Nursing home abuse victimizes the most vulnerable individuals. Although many residents can report mistreatment, some cannot even describe what happened. If your relative or friend is a nursing home resident, you can help by watching out for signs of abuse, including:

• Unexplained injuries
• Inability of nursing home staff to give an adequate explanation of a resident’s condition
• Open wounds, cuts, bruises, welts, or bedsores
• Slapping, pushing, shaking or beating
• Non-verbal signs from the nursing home resident that something is wrong, such as:
  • Unusual emotional outbursts or agitation
  • Extreme withdrawal or lack of communication
  • Unusual behavior, like sucking, biting, rocking, etc.
  • Humiliating, insulting, frightening, threatening or ignoring behavior towards family and friends
  • Desire to be isolated from other people

Signs of Nursing Home Neglect

Neglect means the negligent failure by any person with care or custody of an elderly or a dependent adult to exercise that degree of care that a reasonable person in a similar position would exercise.

Neglect includes, but is not limited to:

• Failure to provide food, clothing, shelter, or help with personal hygiene
• Failure to provide medical care for physical and mental health needs
• Failure to protect from health and safety hazards
• Failure to prevent malnutrition or dehydration
• Failure to provide the necessities of daily living
• Failure to prevent bed sores
• Failure to provide sanitary conditions
• Failure to prevent infections

Specific Examples of Common Nursing Home Abuse or Neglect Injuries

Bedsores

Bedsores are also known as pressure ulcers, pressure sores, and decubitus ulcers. The primary cause of bedsores is unrelieved pressure to a particular part of the body. They also may result from friction, like rubbing against something like a bed sheet, cast, brace, etc., or from prolonged exposure to cold.

Any area of skin tissue directly over a bone is a potential site for a bedsore. These areas include the spine, coccyx or "tailbone," hips, heels, and elbows. The factors that contribute to formation of a bedsore include poor nutrition, poor hygiene, weight loss, diabetes, and dehydration. The least serious kind of bedsore looks like skin discoloration, and may disappear within a few hours after relieving pressure on that area. However, more severe bedsores are profound wounds, which can extend through skin tissue into internal organs or bones.

Medical professionals have identified similarities between bedsores and burns. Like a first-degree burn, a mild bedsore may involve mild redness of the skin and/or blisters. A third-degree or fourth-degree burn, or severe bedsore, may have a deep open wound with a lot of blackened tissue, which is called "eschar." The primary treatment for bedsores starts with removing all pressure from the affected area, to prevent further tissue decay and promote healing. The victim must be turned or repositioned frequently and get enriched nutrition. The affected area must be kept clean, and dead or necrotic tissue should be removed to minimize the risk of infection. The worst bedsores often require a surgical procedure, known as debridement of dead tissue.

If you suspect that a relative or friend is suffering from a bedsore, you need to get immediate medical attention for that individual. In addition, help your loved one get legal assistance. Very frequently, severe bedsores result from abuse and neglect. Federal regulations confirm that there rarely is a valid medical reason for a bedsore to develop into a massive deep wound, which is known as the stage 4 level.

Suffocation and Strangulation

A frail nursing home resident can suffocate or strangle to death in a hospital bed, if ignored or neglected by nursing home staff. Between 1993 and 1996, there were 74 of these cases reported, and probably many more went unreported.

The design of the side rails on a nursing home bed may contribute to the danger. Often side rails have slats that are spaced six or more inches apart. That space may trap an elderly person’s head, causing him or her to strangle, or allow a thin individual to squeeze between the rails and fall to the floor. If the mattress on a nursing home bed does not fit properly in the bed frame, a patient may be trapped and strangle in a gap between the mattress and side-rails.

Broken Bones or Fractures

For the elderly, falling is the most frequent cause of fractures. Nursing home staff must regularly evaluate each patient; determine his or her risk for falling, and provide safety devices and services that each individual needs to minimize the risk of injury. Some of the risk factors for harmful falls include:

• Previous falls
• Cardiac arrhythmias (irregular heartbeat)
• Stroke
• Central nervous system disorders, such as Alzheimer’s disease, Parkinson’s disease, or dementia
• Problems with mobility and gait
• Low blood pressure (orthostatic hypotension) when trying to stand up
• Bowel or bladder incontinence
• Dizziness
• Dehydration
• Visual impairment (i.e. macular degeneration, cataracts, etc.)
• Use of restraints
• Medication side effects
• Slipping or tripping hazards, like torn or loose rugs or mats

The Cost of Nursing Home Abuse or Neglect

The cost can be quite high for the treatment of a victim of nursing home abuse or neglect. Often the resulting injuries are permanent, and may require hospitalization or a higher level of medical treatment and nursing care than your loved one previously needed. This can be an extreme hardship for the victim and his or her family. If the injuries are the fault of a nursing home, then it should have insurance to pay for those substantial bills, other expenses, and damages for pain and suffering. Proving a nursing home abuse or neglect case is a complex process. To succeed, you need a lawyer who is well versed in the complicated laws that govern these legal actions.