In an article appearing in this week’s online edition (June 23, 2014) of JAMA Internal Medicine, it was reported that among the Medicare population studied who suffered a hip fracture, 13% died within three months, 24% died within twelve months, and only 50% of those who survived at least six months after fracturing their hip were able to perform their activities of daily living to the extent they were able to perform them prior to their hip fracture. By six months after suffering a hip fracture, 36% of nursing home residents had died (46% of all male nursing home residents had died).
Long-term nursing home residents are much more likely to suffer a hip fracture, and have poorer functional outcomes, than older adults living in the community — about 20% of the elderly who live in the community will die within one year after suffering a hip fracture but almost one-half of nursing home residents who suffer a hip fracture will die within one year.
The recently reported study involved 60,111 Medicare beneficiaries who resided in nursing homes who had been hospitalized due to hip fractures between July 1, 2005 and June 30, 2009. The researchers found that 21,766 (36.2%) had died within 180 days after sustaining a hip fracture. For the nursing home residents who were not totally dependent in locomotion before they suffered their hip fractures, 53.5% either died or became totally dependent within 180 days after their hip fractures.
Nursing home residents who were over 90 years old experienced the greatest decreases in survival after suffering a hip fracture. Those nursing home residents who were treated nonoperatively for their hip fractures also experienced decreased survival rates as compared to those treated by surgery (internal fixation). Approximately 12% of the Medicare beneficiaries who were studied did not have surgery after sustaining a hip fracture — which is about two times the rate of the general Medicare population.
Nursing home residents who had severe cognitive impairment had the greatest risk of death or new dependence within 180 days of their hip fractures.
The study’s authors concluded: “Survival and functional outcomes are poor after hip fracture among nursing home residents, particularly for patients receiving nonoperative management, the oldest old, and patients with multiple comorbidities and advanced cognitive impairment. Care planning should incorporate appropriate prognostic information related to outcomes in this population.”
Nursing homes are populated by the elderly, the disabled, the cognitively impaired, and others who often need assistance and protection from suffering unintended falls. Nursing home residents are required to be evaluated for their fall risk upon admission, periodically thereafter, and whenever they experience physical, cognitive, or other changes that may increase their risk for falling (such as changes in medications that may affect them physically or mentally). Each nursing home resident who is determined to be at risk for falls must have the appropriate and timely fall prevention protocols established, implemented, and followed.
Many times nursing home residents suffer falls and debilitating injuries due to the failure of the nursing home staff to properly evaluate them for falls and/or to follow necessary fall precautions religiously. Another factor that may lead to unnecessary falls and resulting unnecessary injuries and debilitation is the nursing home’s failure to provide sufficient staff, properly trained staff, and/or adequate levels of care that would have prevented residents from suffering avoidable falls.
If you or a loved one suffered injuries (or worse) due to a fall in a nursing home or due to nursing home neglect, nursing home abuse, or nursing home negligence, you should promptly consult with a local nursing home attorney in your U.S. state who may investigate your nursing home claim for you and represent you in a nursing home negligence case, if appropriate.
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