By Nursing Home Law Center
Hip injuries are one of the most common physical injuries afflicting nursing home patients in the United States, and a patient entering a nursing home after a hip injury or while recovering from a hip injury is far more likely to develop a bed sore than an uninjured resident.
An elderly individual usually faces a higher incidence rate of pressure sore development in an acute care facility, but there is also a significant risk while residing in a nursing home or assisted living facility. Elderly individuals who suffer hip fractures face a dramatically higher pressure ulcer risk throughout the treatment and recovery process.
As we age, our bodies become less resilient against injury and illness. It generally takes longer for older individuals to heal from physical injuries and recover from sickness. Older individuals are also more susceptible to injuries from falling accidents than younger people. An elderly nursing home patient not only faces an increased risk of sustaining hip injuries from accidents as he or she ages, but will also face a longer, more difficult recovery if he or she does sustain a hip injury.
A study from the Journal of the American Geriatrics Society reported that the average patient faces a 36% chance of developing pressure ulcers during the first month of treatment following acute injury treatment admission. This risk declines as recovery continues, and attending caregivers should pay close attention to individual patient risk factors when it comes to preventing bed sores in hip injury patients.
When an elderly individual suffers a hip fracture, he or she will require intensive immediate medical care and long-term rehabilitation following the acute care stage. During this time, he or she will likely remain in bed or in resting positions for most of each day. Caregivers generally stick to a rule of thumb of repositioning patients every two hours, but patients recovering from hip fracture surgery may need more frequent repositioning to prevent the formation of pressure ulcers.
Whenever a nursing home patient remains in bed or in a wheelchair for too long at one time, the risk of a pressure ulcer increases. Nursing home staff must change bedridden patients' position and lift wheelchair-bound patients out of their chairs at regular intervals to prevent bed sores in the lower extremities.
A patient recovering from a hip injury will require rest and moving the affected leg can be difficult. However, regular repositioning is necessary to prevent the formation of bed sores, especially around the vulnerable injury sites such as in the upper legs and lower back.
Even the time spent in the operating room can cause the formation of a pressure ulcer. These injuries escalate very quickly from surface injuries that appear as bruises, then blisters, and finally necrotic open wounds. Surgical teams must account for this risk and consider time spent in the operating room as a vital factor in determining a patient's risk of developing pressure ulcers.
Other risk factors include the patient's age, mobility-restricting medical conditions, nutrition and Body-Mass Index (BMI) rating, medications that affect blood pressure, and diabetic status.
The Centers for Disease Control and Prevention (CDC) reports that roughly 300,000 older individuals suffer hip fractures in the United States each year from falling. Most American nursing home and assisted living facilities assign each new patient a fall risk assessment based on his or her unique medical status, and these facilities generally strive to take appropriate precautions to limit each patient's individual fall risk. Roughly one in five falling incidents results in a serious injury.
The more likely a patient is to sustain a hip injury, the more likely he or she will be to develop a pressure ulcer as a secondary complication, either during surgery or immediately following surgery. The risk of developing a pressure ulcer is generally higher while in an acute medical treatment facility compared to a nursing home so caregivers in these facilities should be very careful to develop repositioning schedules appropriate for each hip injury patient.
Ideally, a patient will follow surgery with a healthy recovery phase and then long-term maintenance, such as physical therapy or other forms of rehabilitation. While exercise may be difficult during the recovery period, caregivers should encourage a reasonable amount of physical activity that is sensitive to each patient's individual risk factors and medical complications. Moving is going to be difficult for a patient immediately following hip surgery, but it is necessary to prevent bed sores.
The recovery phase following hip fracture surgery is an ideal time for an attending physician to develop a comprehensive risk assessment for the patient regarding his or her fall risk, secondary injury risk, and risk of developing pressure ulcers due to factors like nutrition and neurological health.
Taking appropriate precautions and preventing bed sores requires consistent effort, but prevention procedures help limit nursing home patients' risk of developing painful and dangerous pressure ulcers after hip fracture surgery.
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