Injuries to the Elderly

The best treatment for decubitus ulcers, pressure sores (also known as bed sores) is prevention.

Prevention is a must and should be stressed by the health care provider.

Florida laws and federal laws define a bid sore as a “non-event”.

This means pressure sores, or more commonly known as bed sores, should never be left untreated and should be addressed by a facility’s staff immediately when symptoms a possible pressure sore are detected in routine patient daily monitoring. Most insurance’s will cover any needed device, material, or equipment necessary to prevent and treat bed sores. Medicare will not pay a health care facilities and providers for the medical costs attributable to them. The facility or care provider must bear the costs to treat and cure the bed sore when it develops in a resident. Medicare and the federal government believe bed sores should never occur in such settings.

Excessive weight loss, Stage II bed sores and chronic infections continue to be an unacceptable standard of care and an indication of negligent care on the part of a nursing home

Stage I Bed Sore

• Surface reddening of the skin.
• The skin is unbroken and the wound is superficial. This could take on appearance of  a  light sunburn or a first degree burn as well as a beginning of a Decubitus ulcer. Immediate attention is important to determine  what caused bed sore and how can the pressure that created the bed sore be alleviated to cure it.
• If a Stage I bed sore is present closer monitoring of the resident’s skin care and time laying in a bed or sitting on areas where the bed sore formed is critical to avoiding further development of the sore(s).

Stage II Bed Sore

• Blistering of the skin in an area  either broken or unbroken. A partial layer of the skin is now injured.Coverings designed to insulate and absorb and protect the area should be used as prescribed by the attending physician.
• Skin lotions and medications are used to treat, hydrate surrounding tissues, and prevent the wound from getting worse.
• Padding and protective substances to reduce pressure on the area where the bed sore is located is important.
• Facility staff must pay close attention to clearing up, protecting, and preventing spread of the bed sore.
• Proper nutrition and hydration are also important considerations.

Stage III Bed Sore

• In a Stage III bed sore, the wound has progressed to a level where all of the layers of the skin are involved. The wound is deeper and prone to serious infection if not treated aggressively by a wound care specialist.
• On-going aggressive wound care and medical staff oversight of the care plan is necessary to properly manage the treatment protocol, promote healing, and prevent further infection. Stage III bed sores traditionally are known to progress very rapidly if left untreated and result in sepsis and possibly death due to infection in the body.

Stage IV Bed Sore

• If a Stage IV bed sore develops a facility has failed to provide appropriate care and has neglected a resident and is a violation of Florida resident’s rights.
• A Stage IV bed sore has evolved and now spread into underlying muscle tissue, tendons and possibly into the bone.
• A Stage IV bed sore is very serious and often times results in producing life threatening infections if not aggressively treated.
• Anyone with a Stage IV wound requires immediate and intensive medical care by a wound care specialist.
• Surgical removal of the decayed skin, muscle and tissue is often required in the proper treatment and prevention of further infection in the case of Stage IV bed sores.
• A skilled wound care physician, physical therapist or nurse can sometimes successfully treat a smaller diameter wound without the necessity of surgery. Surgery is the usual course of treatment.
• Amputation may result in some situations.
• Gangrene can set in.

• Medication errors in nursing homes and assisted living facilities can be deadly.
• Residents are given pills by facility staff to take and the resident does not know what pills he/she is supposed to be taking. The resident relies on the facility staff to give them the right does and medication.
• The most common medication errors fall into the following broad categories:

1. Medications given to the wrong resident
2. Medications given to a resident who is allergic to the medication
3. Medications given in the wrong dosage (either overdose or underdose)
4. Lack of follow-up after medicating to monitor the effects of the medication

• Good nutrition is critical to the elderly
• A loss of around 5 to 10 percent of body weight in 1 to 12 months may indicate a problem related to malnutrition in an elderly person.
• Drastic weight loss should not be considered a normal part of the aging process.
• Malnutrition can occur due to:Adverse side effects of certain medications,

1. Loss in the sensation of taste,
2. Dislike of the food served in a facility setting,
3. Failure of the body to recognize when it is dehydrated and needs fluids,
4. Dental issues

• Common symptoms of Malnutrition are: fatigue, dizziness, weight loss, weak immune system, anemia, muscle weakness (leads to fall and fractures), digestive problems, lung and heart problems, and poor skin integrity.

• Most individuals with indwelling catheters for more than 7 days have bacteriuria. Residents with a catheter should be monitored closely and checked frequently for symptoms of development of a UTI.
• Common symptoms associated with a UTI include a combination of the following:

1. Fever(increase in temperature of >2 degrees F(1.1 degrees C) or rectal temperature > 99.5 degrees F( 37.5 degrees C) or single measurement of temperature > 100 degrees F(37.8 degrees C) or chills
2. New or increased burning pain on urination, frequently or urgency;
3. New flank or supra-pubic pain or tenderness;
4. Change in character of urine(e.g., new bloody urine, foul smell, or amount of sediment) or as reported by the laboratory( new pyuria or microscopic hematuria); and/or
5. Worsening or mental or functional status (e.g., confusion, delirium, decreased appetite, unexplained falls, lethargy, decreased activity).

• Dehydration occurs when the body does not have enough fluids. Causes include an excess loss of fluids, lack of drinking enough or taking in enough fluids, or both.
• As we age the human body’s response to a requirement for additional nutrients and fluids may diminish. For that reasons, as we age it is easier for us to become severely dehydrated before we actually feel thirsty or symptoms are recognized by others not monitoring the possibilities that dehydration may occur.
• Symptoms of dehydration in the elderly is characterized in many cases as reduced or poor skin elasticity (i.e., When the skin is pinched, it holds its form rather than returning to its normal shape.)
• Dehydration when serious may cause death or other very serious illnesses. It is very important that family and medical staff in facilities are closely monitoring and watching for symptoms of dehydration.

• Infections are very common in nursing homes, and assisted living facilities.
• The most prevalent infections in Nursing Home and Skilled Nursing Facilities are: pneumonia, urinary tract infections (UTI’s), scabies, staph, and sepsis amongst others. Pneumonia is a respiratory infection of the lungs. Germs called bacteria, viruses, and fungi are the primary cause of pneumonia. It is said that over 60% of all respiratory illnesses are Pneumonia.
• Urinary tract Infections are the most common infections occurring among nursing home residents. M any patients who have urinary tract infections are asymptomatic (not show signs of it).
• Scabies, a skin disease is also very prevalent in nursing homes. Scabies is a contagious and infectious skin disease that is caused by the itch mite. Due to their weakened immune systems, Elderly people are more susceptible to scabies than the general population. Outbreaks of scabies are usually reported to happen in hostels, hospital, nursing homes and other places where elderly people reside. If not treated properly scabies can lead to more infections and death.

• Sepsis is a very serious illness where the bloodstream is overwhelmed by bacteria. Symptoms of Sepsis are fever, chill and severe shaking, excessive breathing and heart rate amongst others.
• Sometimes Sepsis can be caused by a urinary tract infection (UTI). This condition involves a buildup of bacteria or toxins in the blood of the urinary tract. This will lead to poisoning of the blood, and can bring on severe health problems like damage of organs, which can result in death.
• Sepsis is a severe infection where the bloodstream is overwhelmed by bacteria. This of course is more deadly in the elderly due to their weakened immune systems. As sepsis gets worse, it affects the body’s organ functions and eventually can lead to septic shock. Symptoms of sepsis included but are not limited to: a) Fever above 101.3° or below 95°, b) Heart rate higher than 90 beats a minute, c) Respiratory rate higher than 20 breaths a minute. Left untreated for too long will result in death.
•  Septic Shock is a serious condition that occurs when an infection leads to life-threatening low blood pressure.
• Residents most susceptible to septic shock including those with Diabetes, AIDS, Leukemia, and Lymphoma.
• The primary treatment in a person with sepsis is the administration of antibiotics.
• Research studies have indicated persons often fail to get sufficient nutrition while they are in the hospital. This may lead to malnutrition, which stresses the immune system and can worsen the effects of sepsis.

• This can occur in nursing home residents when they are not active, mobile, and/or lay in bed for extended periods of time.
• If not detected and treated right away, it can lead to dehydration, electrolyte disturbances, vomiting, respiratory problems, aspiration, bowel ischemia or lack of blood and oxygen to the intestine, bowel death, perforation, sepsis and even wrongful death.
• Symptoms of a bowel obstruction can include cramping, abdominal pain, bloating, vomiting, constipation or lack of bowel movement, inability to pass gas or flatus, or diarrhea.  Bowel obstructions occur when either your small or large intestine becomes partially or completely blocked.  The blockage prevents food, fluids, gas and stool from moving through the intestines.
• It is the ultimate responsibility of the physician to properly diagnose and treat the bowel obstruction before additional problems or injuries arise. Nursing home staff are responsible for day to day monitoring of a residents care to ensure this does not occur. Nursing home staff are supposed to have proper training to recognize the above mentioned symptoms indicate a high risk a resident has or is developing a bowel obstruction. The sooner it is detected the better chances of recovery without serious injury.