California Elder Law Attorney Blog

Fluid is an essential nutrient that is important for the normal functioning of cells. When a patient does not receive enough fluid or their fluid losses exceed their fluid intake, dehydration can occur. Wound drainage from a bed sore, pressure sore and pressure ulcer can be a major source of fluid loss and can lead to dehydration and electrolyte imbalance. Dehydration frequently occurs with malnutrition. Dehydration is a risk factor for pressure ulcer development because it can reduce blood volume, thereby interfering with peripheral circulation and decreasing nutrient and oxygen supply to tissues.

Optimal hydration is attained when fluid intake equals fluid output. Most adults need a minimum of 1,500 to 2,000 ml (6 to 8 glasses) of fluid a day. Fluid is an especially important nutrient for older adults because of their increased risk for dehydration. A rule of thumb is to provide 30 to 35 ml of fluid per kilo gram of body weight per day, or 1 ml of fluid per calorie fed for patients receiving enteral tube feeding. Patients on air-fluidized beds require an additional 10 to 15 ml fluid/kg of body weight to prevent dehydration that can occur from the drying effects of these specialty beds.The dietitian will determine the patient's fluid needs based on the patient's current condition and needs.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers The Importance of Sufficient Nutrition" »

Dehydration occurs when a person does not receive enough liquid through oral consumption or via a feeding tube. Inadequate fluid consumption results in imbalance of the bodies chemistry and reduction of blood volume. Changes in blood volume and chemistry typically interfere with circulation. The decrease in circulation translates to inadequate supply of oxygen and nutrients to tissue- enabling bed sores (also called decubitus ulcers, pressure ulcers or pressure sores) to form says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

Optimal hydration can only be determined by a medical professional after evaluating a patient's fluid intake compared with their fluid output. Nonetheless, an agreed upon starting point is 1,500 to 2,000 ml (six to eight glasses) of fluid per day.

Elderly people are particularly susceptible to dehydration because many they have diminished thirst perception and they wish to avoid embarrassing accidents due to incontinence. Therefore, it is crucial for caregivers to pay special attention to the symptoms of potential dehydration:

* Sunken eyes
* Cracked lips
* Ashen skin
* Rapid decline in cognitive function
* Chills
* Dark colored urine
* Weakness

Continue reading "Can Dehydration Contribute to the Development of Bed Sores, Pressure Sores and Decubitus Ulcers?" »

If your loved one has a bed sore and is later diagnosed with sepsis then there is a strong likelihood that the sepsis is due to the bed sore or open wound. Sepsis is an illness caused by infection in the bloodstream by bacteria.

Sepsis must be identified and treated as early on as possible in order to provide the best chances of survival. If left undiagnosed and untreated, sepsis can be fatal. In order to make a diagnosis of sepsis, at least two of the following must occur: a heart rate above 90 beats per minute, hyperventilation (more than 20 breaths per minute) and white blood cell count below below 4000 cells/mm.

Symptoms of sepsis include:

* Fever
* Low body temperature (hypothermia)
* Loss of ability to appreciate surroundings
* Cool hands and feet
* Anxiety
* Shaking
* Organ dysfunction

Frequently, people use the term sepsis to describe 'severe sepsis' and 'septic shock.' Severe sepsis is used to describe people who have organ dysfunction following a diagnosis of sepsis. People diagnosed with septic shock have sepsis with hypo-tension (abnormally low blood pressure).

Sepsis is a common medical condition; it accounts for:

* 1-2% of all hospitalizations
* 25% of all intensive care visits
* 100,000 deaths per year
* The most common cause of death in intensive care units

In order for treatment to be most effective, it must be implemented as soon as the diagnosis is made. Generally, treatment consists of antibiotics and surgical drainage. Nutritional supplements are also suggested as treatment for sepsis.

Continue reading "Is Sepsis Related to Bed Sores, Pressure Sores and Decubitus Ulcers?" »

Medical complications such as malnutrition, dehydration and bed sores are common consequences of nursing home neglect. In some situations, the aforementioned conditions of malnutrition and dehydration may contribute to the development of bed sores.

* Incontinence - Failure to keep patient clean, change soiled linens after an episode of incontinence, and re-position patients on a regular internals may contribute to the development of bed sores (similarly referred to as: pressure sores, pressure ulcers or decubitus ulcers).

* Dehydration - An inability to perceive thirst or anxiety over going to the toilet are some of the common factors that contribute to dehydration of nursing home patients. Staff must keep track of patients fluid intake and output.

* Malnutrition - We all know food is a basic requirement to keep our bodies functioning properly. Yet, when inappropriate foods (solid foods given to an are given to patients who can not eat them) or no staff assistance is provided to patients who are unable to feed themselves serious health problems may develop.

Nursing Home Liability for Neglect of Patients:

It is not necessary to distinguish the type of neglect nor establish actual intent on the part of the facility to pursue a cause of action premised on neglect. Rather, if your loved one suffered a bed sore, pressure sore or a decubitus ulcer or other type of injury due to inaction on the part of a caretaker, you may be entitled to pursue a claim for the resulting damages.

Continue reading "Malnutrition, Dehydration and Bedsores Are Common Sources of Nursing Home Abuse and Neglect" »

•Warning signs that an elder is being abused by a caregiver include bruises that cannot be explained, behavior changes, arguments between the patient and the caregiver, bedsores and unexplained changes in finances. If a person suspects elder abuse, she should notify the local police immediately. Caregiver laws protect the elderly patient from all forms of abuseSays California Elder Abuse Attorney Steven C. Peck.

Physical Abuse•Physical abuse occurs when the caregiver causes physical or emotional harm to the patient. This can be in the form of physical abuse, where the caregiver assaults the patient; sexual abuse, when the caregiver forces the patient to engage in unwanted sexual conduct; or emotional abuse, when the caregiver belittles the patient. Elder abuse is a serious offense with penalties varying in each state. According to the Montana Codes Annotated, a first-offense elder abuse charge in that state is considered a felony with a penalty up to 10 years in state prison, $10,000 fine or both. If another person is aware of abuse and fails to report it, he may also held responsible.
Neglect•Neglect occurs when the elderly person relies on the caregiver for all her needs and these are not met. These needs can include toileting, feeding, medications and ambulation. Neglect is when a caregiver knowingly refuses to care for the patient. This can include not providing food or medications, or allowing him to be alone for an extended period when she is the under the caregiver's care. Neglect also occurs if the patient requires turning in bed every two hours to prevent bedsores and this is not done. The penalty in Montana is the same for neglect as it is for abuse.
Financial Fraud•Elderly patients and the families establish trust with their caregivers. This is how the caregiver can take advantage of the patient by either asking for money or convincing her to give the caregiver power of attorney over his finances. This is considered financial fraud. No person is to exploit an elderly person into giving him money or other financial assets. .

Bedsores, Pressure Sores and Decubitus Ulcers are easier to prevent than to treat, but that doesn't mean the process is easy or uncomplicated. Although wounds can develop in spite of the most scrupulous care, it's possible to prevent them in many cases. says California Elder Abuse Attorney Steven C. Peck.

The first step is to work with your nurses and doctor to develop a plan that you and any caregivers can follow. The cornerstones of such a plan include position changes along with supportive devices, daily skin inspections and a maximally nutritious diet.

Position changes:
Changing your position frequently and consistently is crucial to preventing bedsores. It takes just a few hours of immobility for a pressure sore to begin to form. For that reason, experts advise shifting position about every 15 minutes that you're in a wheelchair and at least once every two hours, even during the night, if you spend most of your time in bed. If you can't move on your own, a family member or caregiver must be available to help you.

A physical therapist can advise you on the best ways to position yourself in bed, but here are some general guidelines:

* Avoid lying directly on your hipbones. On your side, lie at a 30-degree angle.
* Support your legs correctly. When lying on your back, place a foam pad or pillow -- not a doughnut-shaped cushion -- under your legs from the middle of your calf to your ankle. Avoid placing a support directly behind your knee -- it can severely restrict blood flow.
* Keep your knees and ankles from touching. Use small pillows or pads.
* Avoid raising the head of the bed more than 30 degrees. A higher incline makes it more likely that you'll slide down, putting you at risk of friction and shearing injuries. If the bed needs to be higher when you eat, place pillows or foam wedges at your hips and shoulders to help maintain alignment.
* Use a pressure-reducing mattress or bed. You have many options, including foam, air, gel or water mattresses. Because these can vary widely in price and effectiveness, talk to your doctor about the best choice for you. For some people, a low-air-loss mattress may provide enough support. But more expensive and technologically sophisticated beds may be needed for people who have recurring pressure sores or who are at very high risk.

Pressure-release wheelchairs, which tilt to redistribute pressure, may make sitting for long periods easier and more comfortable. If you don't have a pressure-release chair, you or your caregiver will need to manually change your position every 15 minutes or so. If you have movement and enough strength in your upper body, you can do wheelchair push-ups -- raising your body off the seat by pushing on the arms of the chair.

All wheelchairs need cushions that reduce pressure and provide maximum support and comfort. Various cushions are available, including foam, gel, and water- or air-filled cushions. Although they may help relieve pressure, cushions and other devices don't prevent pressure sores from forming or replace the need to change your position often.

Skin inspection:
Daily skin inspections for pressure sores are an integral part of prevention. Inspect your skin thoroughly at least once a day, using a mirror if necessary. A family member or caregiver can help if you're not able to do it yourself indicates California Nursing Home Abuse and Neglect lawyer Steven C. Peck.

If you're confined to bed, pay special attention to your hips, spine and lower back, shoulder blades, elbows and heels. When you're in a wheelchair, look especially for sores on your buttocks and tailbone, lower back, legs, heels and feet. If an area of your skin is red or discolored but not broken, keep pressure off the sore, wash it gently with mild soap and water, dry thoroughly, and apply a protective wound dressing.

If you see skin damage or any sign of infection such as drainage from a sore, a foul odor, and increased tenderness, redness and warmth in the surrounding skin, get medical help immediately.

Nutrition:
A healthy diet is important in preventing skin breakdown and in aiding wound healing. Unfortunately, the people most likely to develop pressure sores are also often the most malnourished states California Elder law Attorney Steven C. Peck.

If you're ill, recovering from surgery or living with paralysis, you may have little appetite and eating may be physically difficult. Yet it's essential to get enough calories, protein, vitamins and minerals. A dietitian can help devise an eating plan that caters to your food preferences while supplying necessary nutrients. These measures also may help:

* Try smaller meals. If you feel full after eating only a small amount, try eating small meals more frequently when you do get the urge to eat. If you never seem to feel hungry, it's often helpful to eat according to a schedule rather than to rely on appetite.
* Take advantage of the times when you feel your best. Eat a larger meal when you're hungry. Many people have their best appetite in the morning, when they're rested.
* Limit fluids during meals. Liquids can fill you up and prevent you from eating higher calorie foods. Don't restrict your intake of water overall, however. It helps keep skin soft and supple.
* Consider pureed or liquid meals. If swallowing is difficult, emphasize soups, pureed foods or nutritional supplement drinks, which provide protein and calories but require little or no preparation. It may be easier for you to drink rather than to eat something.
* Consider protein alternatives. If meat isn't appealing to you, consider other high-protein foods such as cottage cheese, peanut butter, yogurt and custards. Beans and nuts also are good protein sources but may be hard to digest.
* Find a comfortable position. Raise the head of your bed to a comfortable level while you eat.
* Don't rush. Allow sufficient time for meals, and if you need assistance, don't let your caregiver rush you.

Lifestyle changes
Although you may need assistance with many aspects of your care, you can take control of some important preventive measures, including:

* Quitting smoking. Ask your doctor about the most effective way to stop smoking. Tobacco use damages your skin and slows wound healing.
* Exercise. Daily exercise improves circulation, builds up vital muscle tissue, stimulates your appetite and strengthens your body overall. A physical therapist can recommend an exercise program tailored to your needs.
* Support. Your physical and emotional well-being depend on having a strong support system. Don't be afraid to ask for help with daily tasks or for emotional support.

Continue reading "Bedsores, Pressure Sores and Decubitus Ulcers Are Easier to Prevent Than to Treat, " »

1. Positioning in bed
1. Avoid positioning patient on ulcer
2. Use positioning device to keep ulcer off surface
3. Avoid donut-type devices (may cause ulcers)
4. Written repositioning schedules every 2 hours
2. Prevention for patients at risk
1. Avoid positioning immobile patients on trochanters
2. Use pillows and foam wedges
1. Relieve heel pressure
2. Relieve bony prominence pressure (knee and ankle)
3. Sheepskin does not relieve pressure
3. Maintain head of bed at lowest appropriate level
1. Limit time head of bed is elevated
2. Higher head of bed causes patient to slide down
1. Sliding leads to shear forces
2. Sacral ulcers may result
2. Management: Bed Types
1. Static Surfaces
1. Surface types
1. Mattress
2. Foam
3. Static floatation
2. Indications
1. Patient in many positions without loading ulcer
2. No bottoming out of patient
3. Fully compresses surface to <1" at injury site
2. Dynamic Surfaces
1. Surface types
1. Air-fluid (costs $100 per day)
2. Low-air (costs $65 per day)
3. Alternate air
2. Indications for all dynamic surfaces
1. Stage 3 or 4 Decubitus Ulcers
2. Conditions not met for static surface bed
3. Pressure Ulcer not healing by 2 to 4 weeks
3. Additional indications for air-fluid or low-air bed
1. Large Stage 3 to 4 Ulcers
2. Ulcers on multiple turning surfaces
3. Ulcer fails to heal on dynamic overlay
3. Management: Tissue loads while sitting
1. Avoid pressure on ulcer while sitting
2. Properly position
1. Consider patient weight
2. Consider balance
3. Consider patient stability
3. Reposition so pressure points shifted once per hour
1. Return to bed if this schedule can not be met
2. Attempt to teach patient to shift weight every 15 min
4. Appropriate seat cushion (avoid donut-types)

Decubitus ulcer:
Ulceration caused by prolonged pressure in patients permitted to lie too still for a long period of time; bony prominences of the body are the most frequently affected sites; ulcer is caused by ischemia of the underlying structures of the skin, fat, and muscles as a result of the sustained and constant pressure. says California Nursing Home Abuse and Neglect Attorney Steven C. Peck.

An ulceration caused by prolonged pressure on the SKIN and TISSUES when one stay in one position for a long period of time, such as lying in bed. The bony areas of the body are the most frequently affected sites which become ischemic (ISCHEMIA) under sustained and constant pressure.

Common Names:Bed sore, Bed Sores, Bedsore, Bedsores, Contact ulcer, Decubitus, Decubitus pressure sore, DECUBITUS SKIN ULCER, Decubitus ulcer, Decubitus ulcer any site, Decubitus Ulcers, Pressure Sore, Pressure Sore Or Ulcer, pressure sores, Pressure Sores/Ulcers, Pressure Ulcer, Pressure Ulcers

Bed sores, Pressure Sores are ulcers with different possible degrees of severity, appearing on human bodies. Decubitus ulcers by nature, these are also often referred to as bed sores. The severity of such a sore can range between a mild pink temporary spot on the body that gets removed within a few hours of removing the pressure to glaring ulcers that pierce deep into the body exposing the inner organs or bones. This form of ulcer can potentially be extremely painful, and people bedridden because of prolonged periods of illness, paralysis and fractured bones are even known to die from septic conditions occurring because of severe bedsores. So, understanding and taking the right care of health to avoid and cure these ulcerous lesions is extremely important.

Symptoms:
There are four stages of a bed sore depending upon its level of severity. The levels have been formally classified by the National Pressure Ulcer Advisory Panel. The stages are the following.
Stage 1: The sore starts appearing as a persistent pink or reddish skin. It may itch or hurt, and a touch on this area may feel soft and warm.
Stage 2: Skin loss starts happening - both the outer and inner layers of the skin start getting lost - and the pressure sores start appearing like blisters.
Stage 3: The bed ulcer now goes deep into the tissues below the skin. A hollow wound is clearly visible. By now it is extremely painful.
Stage 4: By now there is damage to underlying muscles and possible exposure of bones. The ulcer now is in extremely advanced stages.

Causes:
Bed sores are caused by sustained pressure applied on a certain section of the body. These are typically seen to occur more above the portions having bones and cartilages. The primary causes of these wounds are the following.
Pressure: Sustained pressure applied on some parts of the body is the most frequent cause of catching these ulcers. This happens most often in cases where the patient is immobile. Examples of immobility are fractures and paralyses, to name a few. The tissues under continuous pressure get deprived of the desired levels of nutrients including oxygen. This leads to bed sores.
Friction: Friction happening often enough at given areas of the body can potentially lead to these ulcerous wounds. Turning side-to-side too frequently and skidding down the wheelchairs are some primary sources of harmful friction.

:
They say, prevention is better than cure. Your best option to protect yourself against decubitus ulcers is to protect yourself. There are devices specially designed for these purposes. The exact device to use would depend upon the depth and stage of the ulcer, including its level of severity and position of the sore wound on the body. Usually, medical insurances cover the cost of such devices - but it is advisable to double-check with your insurance provider before you commit.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers Are Extremely Painful and Will Cause Death" »

•Abuse of elderly citizens is a growing issue in California. According to Elder Abuse Daily (eadaily.com), approximately 160,000 cases of elder and nursing home abuse occur each year in Los Angeles County, accounting for about 25 percent of the state average of cases. The three primary forms of elderly abuse are physical, emotional and financial exploitation. Several national and state laws protect the elderly, provide guidance about reporting the crimes, and outline punishment for the abusers.
The Nursing Home Reform Act
•According to the California Department of Aging, people living in long-term care environments are vulnerable to abuse because of their physical and mental frailty, and dependency on others for personal and medical care. The Nursing Home Reform Act (NHRA), which President Ronald Reagan signed into law in 1987, was the first major revision of the federal standards for nursing home care since the Medicare and Medicaid in 1965. The NHRA and California state law both recognize the rights of elderly and dependent individuals and explain that those residents "have the right to be free from abuse."

The NHRA entitles all residents to quality of life in a caring environment, improving or maintaining their physical and mental health. That includes freedom from neglect, abuse and mishandling of their personal or financial property. The law describes neglect and abuse as "criminal acts," no matter where they occur. The document also points out that nursing home residents "do not surrender their rights to protection from criminal acts when they enter a facility."
The Older Californians Act
•The Mello-Granlund Older Californians Act (OCA), established in 1996, outlines the rights of elderly citizens and provides structured guidelines for community involvement and elder abuse prevention.

The Older Americans Act (OAA), passed by Congress in 1965, requires representatives called "ombudsmen" to serve long-term care residents, 60 years or older, and maintain an awareness of their treatment. The OAA is a United States code and applies to every state. California law also requires ombudsmen to receive and review allegations and suspicions of elderly abuse.
Welfare and State Penal Codes
•The Welfare and Institutions Code (Chapter 11, Elder Abuse and Dependent Adult Abuse Civil Protection Act, Sections 15630); and California State Penal Code (Section 368) were both established to help protect elderly citizens and their rights.

An EADACPA claim of abuse is a civil action and includes physical abuse, neglect, financial abuse, abandonment, isolation or other destructive treatment. Elder abuse protection applies to anyone over 65 years of age, or a dependent adult between the ages of 16 and 64 who cannot physically or mentally care for themselves.

The Penal Code reads: "The Legislature finds and declares that crimes against elders and dependent adults are deserving of special consideration and protection, not unlike the special protections provided for minor children, because elders and dependent adults may be confused, on various medications, mentally or physically impaired, or incompetent, and therefore less able to protect themselves, to understand or report criminal conduct, or to testify in court proceedings on their own behalf."

Continue reading "Elder Abuse Is Growing in The State of California" »

Because of the fact that elderly and disabled men and women come to be patients of rest homes due to failing mental capabilities and physical abilities, they're the people who are most susceptible to nursing home abuse and neglect. Far too many people are put through physical, sexual, emotional and economic abuse at the hands of men and women entrusted to care for our loved ones. As soon as a member of the family has fallen victim to nursing home neglect and abuse, contact Steven C. Peck toll free at 1.866.999.9085.

Different types of Nursing Home Abuse and Neglect:

Many times, elderly and handicapped people are put under the care of over-worked and undertrained nursing home staff members. Insufficient guidance compounds the difficulties experienced by defenseless people. Here are some of the forms of nursing home negligence which can be most typical:

•Physical assault and battery
•Excessive restraints
•Malnutrition and dehydration
•Overmedication of sedative drugs
•Bedsores and insufficient hygiene
•Insufficient medical treatment
•Improper oversight

Continue reading "Nursing Home Patients Are the Most Susceptible To Nursing Home Abuse and Neglect" »

It is well known, and expressly noted by the California Legislature, that the elderly segment of the population is particularly subject to various forms of abuse and neglect. Welfare & Institutions code §15600(a) - (d). Physical infirmity or mental impairments, such as those suffered by elders, often place the elderly in a dependent and vulnerable position. See id. At the same time, these impairments have left the elderly, and elders, incapable of asking for help and/or protection.

The California Legislature has promulgated the Elder Adult and Dependent Adult Civil Protection Act (EADACPA), codified in California Welfare & Institutions Code §§ 15657 through 15657.3. The purpose and intent of the inclusion of California Welfare & Institutions Code §§ 15657 through 15657.3 in the EADACPA is made clear by the simultaneous addition of subsections (h) and (j) to California Welfare & Institutions Code §15600. Pursuant to California Welfare & Institutions Code §15600(h), the Legislature declared that infirm, elderly and dependent adults are a disadvantaged class, and that few civil cases are brought in connection with their abuse due to problems with proof, delays and lack of incentives to prosecute these suits.

EADACPA defines an "elder," as any person residing in California who is and adult sixty-five (65) years of age or older, such as the decedent herein. Abuse under an EADACPA claim in a civil action includes "physical abuse" as defined in California Welfare & Institutions Code §15610.63 (d), as well as "neglect," as defined in California Welfare & Institutions Code §15610.57
EADACPA has defined "neglect," under California Welfare & Institutions Code §15610.57, to mean:

"Neglect" is the negligent failure of any person having care or
custody of an elder or dependent adult to exercise that degree of care
which a reasonable person in a like position would exercise.'Neglect'
includes but is not limited to all of the following:...(2) failure to
provide medical care for physical and mental needs.

Continue reading "Elderly Segment of The Population Is Particulary Subject To Elder Abuse and Neglect" »

The terms decubitus ulcer and pressure sore often are used interchangeably in the medical community. Decubitus, from the Latin decumbere, means "to lie down." Decubitus ulcer, therefore, does not adequately describe ulceration that occurs in other positions, such as prolonged sitting (eg, the commonly encountered ischial tuberosity ulcer). Because the common denominator of all such ulcerations is pressure, pressure sore is the better term to describe this condition.

A study by Howard and Taylor found the incidence of pressure sores in nursing home residents in the southeastern United States to be higher in black patients than in white ones. The authors examined data from 113,869 nursing home residents, none of whom had pressure sores at nursing home admission. They determined that 4.7% of black residents developed postadmission ulcerations, compared with 3.4% of white residents. In addition, the racial differences in pressure sore incidence displayed a sex predilection based on patient characteristics. The variation in incidence between black and white males occurred in residents who were dependent in mobility, while in females, such variation occurred in black and white residents who were bedfast and living in nursing homes with fewer than 200 beds.

History of the Procedure
Pressure sores have probably existed since the dawn of our infirm species. They have been noted in unearthed Egyptian mummies and addressed in scientific writings since the early 1800s. Presently, treatment of pressure sores in the United States is estimated to cost in excess of $1 billion annually.

Problem
Pressure is exerted on the skin, soft tissue, muscle, and bone by the weight of an individual against a surface beneath. These pressures are often in excess of capillary filling pressure, approximately 32 mm Hg. In patients with normal sensitivity, mobility, and mental faculty, pressure sores do not occur. Feedback, conscious and unconscious, from the areas of compression leads individuals to change body position. These changes shift the pressure prior to any irreversible tissue damage.

Individuals who are unable to avoid long periods of uninterrupted pressure over bony prominences--a group of patients that typically includes elderly individuals, persons who are neurologically impaired, and patients who are acutely hospitalized--are at increased risk for the development of necrosis and ulceration. These individuals cannot protect themselves from the pressure exerted on their body unless they consciously change position or have assistance in doing so. Even the most conscientious patient with an extensive support group and unlimited financial resources may develop ulceration resulting from a brief lapse in avoidance of the ill effects of pressure.

Frequency
Two thirds of pressure sores occur in patients older than 70 years. The prevalence rate in nursing homes is estimated to be 17-28%.

Among patients who are neurologically impaired, pressure sores occur with an annual incidence of 5-8%, with lifetime risk estimated to be 25-85%. Moreover, pressure sores are listed as the direct cause of death in 7-8% of all paraplegics.

Patients hospitalized with acute illness have a pressure sore incidence rate of 3-11%. In a study of 658 patients aged 65 years or older who underwent surgery for hip fracture, Baumgarten et al found that 36.1% developed an acquired pressure sore within 32 days after hospital admission.5 (The authors defined an acquired pressure sore as one that arose after hospital admission and had reached stage II or higher.) Although the 32-day period included time spent by patients in rehabilitation facilities and nursing homes, the highest incidence rate for pressure sores occurred during the patients' acute hospital stays.

Disturbingly, even with current medical and surgical therapies, patients who achieve a healed wound have recurrence rates of as high as 90%.

Etiology
Many factors contribute to the development of pressure sores, but pressure leading to ischemia is the final common pathway. Tissues are capable of withstanding enormous pressures when brief in duration, but prolonged exposure to pressures slightly above capillary filling pressure initiates a downward spiral towards ulceration.
Impaired mobility is an important contributing factor. Patients who are neurologically impaired, heavily sedated, restrained, or demented are incapable of assuming the responsibility of altering their position to relieve pressure. Moreover, this paralysis leads to muscle and soft-tissue atrophy, decreasing the bulk over which these bony prominences are supported.

Contractures and spasticity often contribute by repeatedly exposing tissues to pressure through flexion of a joint. Contractures rigidly hold a joint in flexion, while spasticity subjects tissues to considerable repeated friction and shear forces.

Sensory loss also contributes to ulceration, by removing one of the most important warning signals, pain.

Paralysis and insensibility also lead to atrophy of the skin with thinning of this protective barrier. The skin becomes more susceptible to minor traumatic forces, such as friction and shear forces, exerted during the moving of a patient. Trauma causing deepithelialization leads to transdermal water loss, creating maceration and adherence of the skin to clothing and bedding, which raises the coefficient of friction for further insult.

Malnutrition, hypoproteinemia, and anemia reflect the overall status of the patient and can contribute to vulnerability of tissue and delays in wound healing. Poor nutritional status certainly contributes to the chronicity often observed with these lesions. Anemia indicates poor oxygen-carrying capacity of the blood. Vascular disease also may impair blood flow to the region of ulceration.

Bacterial contamination from improper skin care or urinary or fecal incontinence, while not truly an etiological factor, is an important factor to consider in the treatment of pressure sores and can delay wound healing.

Pathophysiology
The inciting event for a pressure sore is compression of the tissues by an external force, such as a mattress, wheelchair pad, or bed rail. Other traumatic forces that may be present include shear forces and friction. These forces cause microcirculatory occlusion as pressures rise above capillary filling pressure, resulting in ischemia. Ischemia leads to inflammation and tissue anoxia. Tissue anoxia leads to cell death, necrosis, and ulceration.

Irreversible changes may occur after as little as 2 hours of uninterrupted pressure.

Presentation
Clinical presentation of pressure sores can be quite deceiving to the inexperienced observer. Soft tissues, muscle, and skin have a differential resistance to the effects of pressure. Generally, muscle is the least resistant and will necrose prior to skin breakdown. Also, pressure is not equally distributed from the bony surface to the overlying skin. Pressure is greatest at the bony prominence, decreasing gradually towards the periphery. Once a small area of skin breakdown has occurred, one may be viewing only the tip of the iceberg, with a large cavity and extensive undermining of the skin edges.

Many classification systems for staging pressure ulcers have been presented in the literature. The most widely accepted system is that of Shea, which has been modified to represent the present National Pressure Ulcer Advisory Panel classification system. This system consists of 4 stages of ulceration but is not intended to imply that all pressure sores follow a standard progression from stage I to stage IV. Nor does it imply that healing pressure sores follow a standard regression from stage IV, to stage I, to healed wound. Rather, it is a system designed to describe the depth of a pressure sore at the specific time of examination, in order to facilitate communication among the various disciplines involved in the study and care of such patients.

Stage I represents intact skin with signs of impending ulceration. Initially this would consist of blanchable erythema from reactive hyperemia that should resolve within 24 hours of the relief of pressure. Warmth and induration also may be present. Continued pressure creates erythema that does not blanch with pressure. This may be the first outward sign of tissue destruction. Finally, the skin may appear white from ischemia.

Stage II represents a partial-thickness loss of skin involving epidermis and possibly dermis. This lesion may present as an abrasion, blister, or superficial ulceration.

Stage III represents a full-thickness loss of skin with extension into subcutaneous tissue but not through the underlying fascia. This lesion presents as a crater with or without undermining of adjacent tissue.

Stage IV represents full-thickness loss of skin and subcutaneous tissue and extension into muscle, bone, tendon, or joint capsule. Osteomyelitis with bone destruction, dislocations, or pathologic fractures may be present. Sinus tracts and severe undermining commonly are present.

Other important characteristics of the wound should be noted in addition to depth. One should note the presence or absence of foul odors, wound drainage, eschar, necrotic material, and soilage from urinary or fecal incontinence. This provides information regarding the level of bacterial contamination and the need for débridement or diversionary procedures.

The overall state of health, comorbidities, nutritional status, mental status, and smoking history also should be noted. Presence or absence of contractures and spasticity also are important in the formulation of a treatment plan. One should note where the patient normally resides and the extent of his or her support structure. Examining the support surfaces present on the patient's bed or wheelchair also is important.

Relevant Anatomy
The hip and buttock regions account for 67% of all pressure sores, with ischial tuberosity, trochanteric, and sacral locations being most common. The lower extremities account for an additional 25% of all pressure sores, with malleolar, heel, patellar, and pretibial locations being most common.

The remaining 10% or so of pressure sores may occur in any location that experiences long periods of uninterrupted pressure. Nose, chin, forehead, occiput, chest, back, and elbow are among the more common of the infrequent sites for pressure ulceration. No surface of the body can be considered immune to the effects of pressure.

Continue reading "Pressure Sores, Bed Sores and Decubitus Ulcers: A Study of Incidence" »

The Agency for Health Care Policy and Research, since renamed and known as AHRQ (Agency for Healthcare Research and Quality), has adopted the most widely used staging system, and is consistent with the National Pressure Ulcer Advisory Panel and the International Association for Enterostomal Therapy. The staging is as follows:

· Stage I: Nonblanchable erythema of intact skin; the heralding lesion of skin ulceration. Note: Reactive hyperemia can normally be expected to be present for one-half to three-fourths as long as the pressure occluded blood flow to the area (Lewis, and Grant, 1925). This should not be confused with a Stage I pressure ulcer.

· Stage II: Partial thickness skin loss involving epidermis and/or dermis. The ulcer is superficial and presents clinically as an abrasion, blister, or shallow crater.

· Stage III: Full thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend down to, but not through, underlying fascia. The ulcer presents clinically as a deep crater with or without undermining of adjacent tissue.

· Stage IV: Full thickness skin loss with extensive destruction, tissue necrosis or damage to muscle, bone, or supporting structures (for example, tendon or joint capsule). Note: Undermining and sinus tracts may also be associated with Stage IV pressure ulcers.

Staging definitions recognize these assessment limitations:

· Identification of Stage I pressure ulcers may be difficult in patients with darkly pigmented skin.

· When eschar is present, accurate staging of the pressure ulcer is not possible until the eschar has sloughed or the wound has been debrided.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers - Staging" »

People who lay or sit in one position for long periods are at risk of developing pressure sores, also known as bedsores or decubitus ulcers. Nursing home residents are more likely to be confined to beds or chairs for long periods of time, and therefore more susceptible to developing pressure sores.

Bedsores or pressure sores occur when pressure on the skin shuts off blood vessels, depriving skin tissue of oxygen and nutrients. Most of us associate this feeling with "pins and needles" or "my leg fell asleep." For most of us, shifting our weight or body position quickly gets us the feeling back in the affected body part. For nursing home residents, this is not always something they can do on their own. Good or proper nursing care is needed to identify and treat these issues for many nursing home residents. Bad or inattentive care can likewise lead to the development of these dangerous pressure sores.

If proper care is not given, large, deep sores can develop, sometimes exposing the muscle or bone below the skin. Untreated pressure sores can lead to infection, severe pain and death. This is especially true because incontinent residents often develop these open pressure sores in the sacral area of the low back. When a resident cannot control their bowel function, and they have a sacral pressure ulcer, infections such as E. Coli and MRSA often develop with easy entry in to the resident's blood stream.

Generally, pressure sores can be prevented with proper care. Federal law requires nursing homes must make sure that residents entering the facility do not develop pressure sores; and that residents who have them are given treatment to promote healing and prevent infection. To prevent pressure sores, nursing homes must keep a resident's skin clean and dry, maintain good nutrition and keep pressure off of vulnerable parts of the body. Changing the resident's position as often as necessary relieves pressure. Good nursing practice usually dictates "turning and repositioning" the resident at least every two hours. Pressure relieving devices, such as pads and special mattresses, can also help when used timely and properly.

A nursing home must notify the resident's physician immediately if he or she develops a pressure sore. Lack of communication is the biggest complaint I hear from family members. The nursing home has an obligation to communicate with the resident's family about changes in their condition, as well as with the resident's primary care physician. Nursing homes are often slow to notify the family or the physician when a pressure sore is developing in the early stages.

Considering that pressure sores can be so dangerous, even deadly, it is unclear why nursing homes are slow to communicate their existence early in the process. The nursing home resident has a much better chance for the pressure sore to heal if the wound is identified early, and a treatment plan is established. The longer the delay, the worse the wound gets; and the harder it is to treat.

It is unfortunate that good nursing care for pressure sores in a nursing home setting often takes a back seat to a culture of overworked caregivers. These staff members know what to do, but often don't have enough time to do it due to a chronic culture in the nursing home industry of understaffing.

If you have a loved one in a nursing home, here are some things you can do to protect them from debilitating pressure sores:

1. Inspect their bodies for wounds or blemishes.
2. Ask to see body parts that are covered with bandages.
3. Ask if your loved one needs a turning and repositioning schedule.
4. Ask the nursing home if they maintain logs documenting that the care was provided.

Immediately contact your loved one's primary care physician if you suspect your loved one has developed a pressure sore to be sure the wound is properly indentified, and that an appropriate care plan is immediately instituted.

Bedsores fall into one of four stages based on their severity. The National Pressure Ulcer Advisory Panel, a professional organization dedicated to the prevention and treatment of pressure sores, has defined each stage as follows:

* Stage I. A pressure sore begins as a persistent area of red skin that may itch or hurt and feel warm and spongy or firm to the touch. In blacks, Hispanics and other people with darker skin, the mark may appear to have a blue or purple cast, or look flaky or ashen. Stage I wounds are superficial and go away shortly after the pressure is relieved.
* Stage II. At this stage, some skin loss has already occurred -- either in the outermost layer of skin (the epidermis), the skin's deeper layer (the dermis), or in both. The wound is now an open sore that looks like a blister or an abrasion, and the surrounding tissues may show red or purple discoloration.
* Stage III. By the time a pressure ulcer reaches this stage, the damage has extended to the tissue below the skin, creating a deep, crater-like wound.
* Stage IV. This is the most serious and advanced stage. A large-scale loss of skin occurs, along with damage to underlying muscle, bone, and even supporting structures such as tendons and joints.

If you use a wheelchair, you're most likely to develop a pressure sore on:

* Your tailbone or buttocks
* Your shoulder blades and spine
* The backs of your arms and legs where they rest against the chair

When you're bed-bound, pressure sores can occur in any of these areas:

* The back or sides of your head
* The rims of your ears
* Your shoulders or shoulder blades
* Your hipbones, lower back or tailbone
* The backs or sides of your knees, heels, ankles and toes

Continue reading "Bedsores, Pressure Sores and Decubitus Ulcers Fall Into One of Four Stages Based Upon Severity" »

Los Angeles elder abuse is on the rise, and the statistics are as staggering as they are unconscionable. According to EADaily.com, more than 25% of all cases of elder abuse in California occur in Los Angeles County, representing approximately 160,000 cases each year. It's difficult to know the exact extent of Los Angeles elder abuse because it often goes unreported.

How do we save our seniors from being taken advantage of physically, emotionally, financially, or otherwise? How can we stamp-out Los Angeles elder abuse?

Signs of Los Angeles Elder Abuse:

Preventing elder abuse in Los Angeles begins with recognizing the many warning signs. In general, sudden changes in behavior and/or personality are common signs that a senior is being abused in some way. Elder abuse includes:

•Physical Abuse: The physical abuse of seniors, who are among the most defenseless among us, is far too common. However unfathomable it may seem to most of us, Los Angeles elder abuse occurs every day and has many symptoms. Physical abuse ranges from unexplained scars or bruises to sprains and even broken bones. But it also includes misusing prescription drugs (too much or too little), marks on wrists indicating the use of restraints, and other tell-tale signs of Los Angeles elder abuse.

•Emotional Abuse: Psychological abuse can be just as damaging as physical abuse. Emotional abuse can be both verbal and nonverbal. For instance, verbal elder abuse of a Los Angeles senior could include intimidation through constant threats and yelling to the use of humiliation and ridicule. Nonverbal emotional abuse can include ignoring basic needs and isolating him from family and friends.

•Financial Abuse: Another common Los Angeles elder abuse crime is taking advantage of an elderly person's condition to steal money. Since most seniors are on a fixed income, this type of abuse can be especially devastating. Signs include suspicious changes in insurance policies, wills, titles, and power of attorney, as well as large amounts of cash missing from the senior's bank accounts or home.

•Healthcare Fraud and Abuse: Medical identity theft and healthcare fraud are rampant in every part of the population, but the elderly are especially vulnerable. Regularly check explanation of benefits (EOB), annual statements from his health insurance company, and credit reports for any abnormal activity. Ensure the EOB includes the healthcare facilities he actually visited, the doctors who actually treated him, and the treatments he actually received. You can also prevent Los Angeles elder abuse by checking for inaccuracies in the insurance statements that show all of the benefits paid for the year.

•Sexual Abuse: This crime transcends age and gender. Signs of sexual elder abuse among Los Angeles seniors include bruises or bleeding around the genitals and bloody undergarments.

•Neglect: Another common type of Los Angeles elder abuse is neglect by caregivers. Neglect can be seen in the form of bedsores, weight loss, dehydration, being unbathed, improperly clothed, and even living in a home without heat or running water.

Continue reading "Elder Abuse Is On The Rise In Los Angeles" »

Watching for signs of illness in a loved one can be challenging. Some illnesses show up quite clearly, while others have a more subtle effect on daily living. Dehydration, depending on the severity, sometimes creates only small telltale signs while having a big effect on the body, especially in the elderly.

Dehydration occurs when a person loses more water than they take in. It takes an adequate amount of fluid for the body to function properly; for example, to regulate body temperature through sweating, maintain blood pressure, and eliminate bodily waste. If severe enough, dehydration can lead to confusion, weakness, urinary tract infections, pneumonia, bedsores in bed-ridden patients, or even death. In general, a human can survive for only about four days without any fluids.

Elderly dehydration is especially common for a number of reasons: some medications, such as for high blood pressure or anti-depressants, are diuretic; some medications may cause patients to sweat more; a person's sense of thirst becomes less acute as they age; frail seniors have a harder time getting up to get a drink when they're thirsty, or they rely on caregivers who can't sense that they need fluids; and as we age our bodies lose kidney function and are less able to conserve fluid (this is progressive from around the age of 50, but becomes more acute and noticeable over the age of 70). Illness, especially one that causes vomiting and/or diarrhea, also can cause elderly dehydration.

"Everybody has a normal state of body water that relates to their weight. Anything below that (normal state) is dehydration; everything above it is hyperhydration," states California Nursing Home and Abuse Attorney Steven C. Peck.

A person's diet can greatly affect hydration levels: fruits (especially watermelon), vegetables, and soups are mostly water-based. "Day in, day out, a lot of people get their water from foods, as well as behavioral attitudes towards food," Kenney explains. "For instance, when we walk by a water fountain, we tend to take a drink, and we tend to drink when we eat."

In general, larger people need to drink more water, as do athletes and those who perspire heavily, but that may mean more or less than eight glasses a day. "There is no one-size-fits-all remedy," he says.

Instead, he recommends monitoring body weight to keep track of hydration levels. To monitor body weight, one should be weighed every morning. If they've lost two pounds or more from the day before, and especially if they feel thirsty or have a headache, they're probably dehydrated.

Mild dehydration is defined as losing 2 percent of your body weight. Severe dehydration occurs with 4 percent or greater body weight loss. Even mild dehydration can affect a person's health, especially if he already has cardiac or renal problems. "We have measured in the lab cognitive impairment," he says. "With severe dehydration, it puts a greater strain on the heart. Think of a pump trying to pump with less fluid. That would be one of the primary problems."

Elder Abuse Attorney Steven C. Peck says an active 65-year-old who exercises probably doesn't need to weigh herself every day, but a 75-year-old in a nursing home who has had issues with dehydration in the past or has had cardiac issues, should be weighed every day.

Complicating matters is that signs of dehydration in younger people don't always show up in the elderly. For example, if a young person was extremely dehydrated, his skin may be wrinkled or sagging. But, that certainly wouldn't be noticed in most cases of elderly dehydration.

Perhaps because of that delay in diagnosis, elderly dehydration is a frequent cause of hospitalization (one of the ten most frequent admitting diagnoses for Medicare hospitalizations, according to the Health Care Financing Administration), and it can be life-threatening if severe enough.

Other signs of dehydration to look for: confusion, problems with walking or falling, dizziness or headaches, dry or sticky mouth and tongue, sunken eyes, inability to sweat or produce tears, rapid heart rate, low blood pressure or blood pressure drops when changing from lying to standing, and constipation or decrease in urine output. Also check for a decrease in skin turgor--pull up the skin on the back of the hand for a few seconds; if it does not return to normal within a few seconds, the person is dehydrated.

To help make sure your loved one doesn't suffer from elderly dehydration, make sure he or she consumes an adequate amount of fluids during the day; eats healthy, water-content foods such as fruit, vegetables and soups; checks that urine color is light and output adequate (dark urine or infrequency of urination is a classic sign of dehydration).

Seniors also need to be educated to drink even when they're not thirsty. Keeping a water bottle next to the bed or their favorite chair could help, especially if they have mobility issues.

If your loved one is in a nursing home or other care facility, make sure that the staff has a hydration program in place, including assisting residents with drinking, offering a variety of beverages (remember, taste buds change with age, so a beverage they used to enjoy may no longer taste right), and providing drinks not only at mealtimes but in between meals. Also make sure that they monitor residents' weight and assess them if their physical condition or mental state changes. If dehydration is an issue and your loved one takes laxatives or diuretics, speak to his or her doctor about changing medication.

Continue reading "Dehydration Occurs when A Person Loses More Water Than They Take In" »

Bed sores,are ulcers with different possible degrees of intensity, showing up on human bodies. Decubitus ulcers by nature, these types also called as pressure sores. The seriousness of such a sore can range between a gentle light red non permanent area on our bodies which will get removed inside of a couple of hours of removing the pressure to glaring ulcers which pierce deep into the human body exposing the internal bodily organs and also bones. This type of sore could be incredibly painful, and people bedridden as a consequence of extented periods of sickness, paralysis and broken bones are even known to p*** away through septic problems occurring because of severe bedsores. Thus, being familiar with and using the correct attention of health to prevent and get rid of these kinds of ulcerous lesions is rather vital.

Conditions

There are actually four levels of a bed sore based upon it's amount of severeness. The degree have been formally listed in the National Pressure Ulcer Advisory Panel. The levels are the following.

Level 1: The actual sore starts appearing as a constant pink or reddish skin. It may itch or hurt, including a touch on this area may perhaps feel soft along with hot.

Level 2: Skin loss starts taking place - both outer and inner layers of the skin begin getting lost - and the pressure sores begin resembling blisters.

Level 3: The bed ulcer now will go deeply into the tissues below the skin. The hollow wound is clearly visible. By now it really is very painful.

Phase 4: By now there's injury to underlying muscles and also likely exposure of bones. The ulcer now is at very progressed stages.

Causes

Bed sores, Pressuree Sores and Decubitus Ulcers are caused by maintained pressure applied on a specific section of one's body. These are generally typically seen to occur a lot more above the portions having bones and cartilages. The main causes of these chronic wounds are the following.

Pressure: Continual pressure applied on some areas of the body is one of frequent reason for catching these ulcers. This particular happens most often in cases where the patient is immobile. Examples of immobility are fractures and paralyses, to name a few. The tissues beneath continuous pressure get deprived of the desired levels of nutrients such as oxygen. This can lead to bed sores.

Friction: Friction taking place often enough at given areas of one's body could possibly bring about these types of ulcerous wounds. Switching side-to-side too frequently as well as skidding down the wheelchairs are a handful of major sources of damaging friction.

Prevention

They say, prevention is better than cure. Your best option to safeguard yourself against decubitus ulcers would be to protect oneself. Presently there are devices specifically made for these purposes. The exact device to use would depend on the depth as well as stage of the ulcer, including its level of seriousness and position of the sore wound on the body. Usually, medical insurances cover the cost of such devices - but it is best to double-check with your insurance carrier before you decide to commit.

Finally, disregarding bed ulcers can result in severe complications. This includes but isn't limited by cellulitis, sepsis, joint infections, bone issues as well as cancer. So it is vitally essential that you take ample preventive measures to save yourself from bed sores.

Continue reading "Bed Sores, Pressure Sores and Decubitus Ulcers are Slow Killers" »