Hip Fractures Among the Elderly in Nursing Homes

When an elderly person suffers a hip fracture, the injury is sometimes referred to as a “death sentence.” This is particularly true for elderly individuals who are residing in nursing homes. Studies going back to the 1980s showed that 27% of elderly persons who suffer a hip fracture die within one year following the injury. Even when elderly persons survive a hip fracture, they are usually left with decreased mobility and often require assistive devices to walk again. Falls and fall-related injuries can cause a loss of confidence and a fear of future falls, which can also lead to decreased mobility. This lack of mobility can, in turn, lead to other medical complications, such as the development of pressure sores, pneumonia and other serious health conditions.

More recent studies have reaffirmed the potentially devastating effect that a fractured hip can have upon an elderly nursing home resident. Researchers at the Perelman School of Medicine at the University of Pennsylvania examined 60,000 nursing home residents who were hospitalized after suffering fractured hips between 2005 and 2009. What they found was alarming. Their study revealed that within six months of being hospitalized for a hip fracture, 1/3 of the nursing home residents had died. The study also found that of those nursing home residents who survived a hip fracture for longer than six months, 28% remained immobile and became dependent upon caregivers to move around. When the researchers extended the time period to one year for individuals who suffered hip fractures in nursing homes, a staggering 50% of the nursing home residents had died. Statistics for those who were living outside of the nursing home when they suffered a hip fracture were markedly different, as only 20% died within one year of the fracture versus the approximately 50% of nursing home residents.

Risk factors for falls in nursing homes include the resident’s age, mental status, means of voiding, a history of falling within the previous six months, visual impairment, confinement to a chair or bed, gait and balance problems, and medications. The most common causes of falls in nursing homes include failing to properly to assess the resident’s risk of falling, inadequate supervision of the resident, hazardous conditions within the nursing home (slippery or cluttered floors, inadequate lighting, inaccessibility to call lights, improper use of assistive devices), improper height of beds, failure to use bed and wheelchair alarms, and failure to consider the effects of medications which increase a resident’s risk of falling. These common causes of falls in nursing homes almost always boil down to staffing issues; either understaffing or inadequately trained staff, both of which are the responsibility of the owners and operators of the nursing homes.

All nurses and staff in nursing homes should be aware of the risk factors for falls and causes of falls, so that they can take appropriate steps to reduce, if not eliminate, a resident’s risk of falling and being seriously injured. Likewise, individuals who have loved ones in nursing homes should be aware of these factors so that they can ask the right questions of the nursing home staff if they become concerned about a loved one falling. When a nursing home fails to recognize that a resident is at risk for falling or fails to implement interventions to reduce the resident’s risk of falling, life-threatening injuries can occur, as evidenced by the above-referenced studies. When that happens, the nursing home should be held accountable.

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