Cognitive Issues

Delirium: A Common Issue in Los Angeles Nursing Homes that Is Difficult to Diagnose and Proposes Questions Regarding the Quality of Care Provided by Nurses

March 3, 2012 | by Law Offices of Ben Yeroushalmi

The March 2012 issue of the Journal of American Medical Directors Association features an article titled “Detection of Delirium and Its Symptoms by Nurses Working in a Long Term Care Facility.” Because delirium is often difficult to recognize, the article studied the accuracy of nurses in diagnosing delirium in their patients. Although often associated with dementia, delirium distinguishes itself from dementia because it is a disorder that is usually reversible, while dementia is a chronic illness that develops over a span of time. Delirium affects a patient’s attention span, consciousness levels, and overall cognitive abilities. Patients typically experience disorientation, memory loss, difficulty with perception, agitation, and a disrupted sleep cycle.

While delirium can be caused by infections, such as sepsis, some other causes of delirium, according to the article, include dehydration, medications, and the use of a physical restraint. Previous studies have also cited chemical restraints as a significant factor that contributes to the development of delirium. Some commonly used chemical restraints are antipsychotic drugs, which effectively sedate and restrain patients, but have many extremely serious side effects, including delirium.

The key to finding a suitable nursing home for your loved one requires close observation of both the quality and quantity of the facility’s staff. With proper staffing levels, dehydration, among many other health issues, is avoidable. Therefore, if a nursing home has blamed your loved one’s delirium on dehydration, the facility is ultimately at fault for failing to prevent dehydration in the first place. The use of restraints, both chemical and physical, is often another consequence of understaffing. When nurses are preoccupied with so many other patients, they may find it difficult to provide each patient with the individualized care that he or she needs and resort to the use of restraints.

With respect the issue of quality of staffing, the study results showed that nurses recorded more cases of delirium than there actually were. Although treatments for delirium may not actually be harmful to patients who do not actually suffer from it, the results still reveal the poor training programs that facilities often provide to their nurses.

Beyond this specific case that studied accuracy in identifying cases of delirium, the study has further implications that nurses may be inaccurately diagnosing other medical problems, while some may be failing to do so at all. Sometimes in skilled nursing facilities, employees are actually directed to improperly document and diagnose illnesses, in a practice known as “downcoding,” to avoid liability and injury claims against them. Other facilities “upcode” in order to maximize reimbursement claims from government health agencies. We would like to increase your awareness of the manipulation of medical records that occurs in skilled nursing facilities. If you are ever in doubt of the accuracy of your loved one’s medical records, it is best for you to monitor his or her records and physical health yourself, or get a second opinion.

Although the staff at nursing home in which the study was conducted mistakenly overestimated the cases of delirium at their facility, other facilities may be underestimating the number of their patients who suffer from delirium. If the nursing home is failing to recognize that your loved is suffering from delirium, he or she is not receiving proper treatment for it. The study emphasizes the importance of recognizing the onset of delirium early so that the cause can be identified and the problem can be treated immediately, before progressing and worsening. If your loved one’s nursing home is failing to provide your loved one with proper care, he or she is a victim of elder abuse and nursing home neglect.

Scientific Discovery: A New Way to Distinguish Alzheimers from Dementia

December 6, 2011 | by Law Offices of Ben Yeroushalmi

On November 30, 2011, the American Academy of Neurology reported in its online journal Neurology an advancement in scientific knowledge that will help elderly adults universally. Prior to this study, doctors used an FDG marker to detect any changes in the brain’s metabolism that could signify either Alzheimer’s or a type of dementia called frontotemporal lobar degeneration. Although both are types of dementia with very similar symptoms, the treatments for each vary vastly and it is therefore important to distinguish the two in order to determine the best and most effective treatment.

Instead of using an FDG marker, this new method employs a PIB marker that detects a type of brain plaque called amyloid that is associated with Alzheimer’s, but not frontotemporal lobar degeneration. The study found that PIB markers had higher sensitivity rates, and better accuracy and precision in measuring qualitative factors that differentiate Alzheimer’s from frontotemporal lobar degeneration. For purposes of comparison, the PIB marker had a sensitivity rate of 89.5 percent, while the FDG marker had a sensitivity rate of only 77.5 percent.

This scientific advancement has many implications. Beyond the most apparent fact that it will improve the quality of life for many elderly adults worldwide, it also proposes the question of whether or not your loved one is receiving the most advanced and effective treatments, especially if he or she resides in a nursing home. Often, since nursing homes are underfunded and understaffed, they do not have the financial backing to provide your loved one with the best treatments. Nursing homes that are privately owned are often more concerned with personal profit than the well-being of your loved one. This is a direct violation of your loved one’s rights, as nursing home residents are entitled to receive the best possible care in response to any and all of their circumstances.

The quality of care provided by a nursing home is directly linked to its staff. Not only must there be an adequate staff, but this staff must also be well-trained and knowledgeable. Furthermore, caregivers must be continually educated and trained and re-trained as science advances and new discoveries are made. It is crucial that caregivers are kept updated with new treatments because nursing home residents may be suffering from preventable conditions that may even lead to death.

There are so many other unfortunate conditions that are prevalent in nursing homes, such as dehydration and malnutrition, pressure sores, incontinence, infections, and more.

Recent Study Shows that Use of Antipsychotics to Chemically Restrain Nursing Home Residents Directly Aggravates Dementia-Related Agitation

November 23, 2011 | by Law Offices of Ben Yeroushalmi

Studies show that one in five adults residing in nursing homes experience agitation, which can manifest itself as irritability, apathy, or depression. While agitation occurs in adults who are relatively healthy, it becomes problematic when adults who have dementia become agitated because these cases of agitation are more likely to progress into more serious phases. In a study titled “Dementia-Related Agitation,” available in the November 2011 Journal of American Medical Directors Association, John B. Morley studies the relationship between dementia and agitation in nursing home residents and proposes some solutions to this issue.

One cause of agitation is pain. Therefore, it is very important for nursing homes to have high-quality pain management programs such as music therapy, dance therapy, and pet therapy. Psychosocial interactions and exercise therapy have proven to be the most effective treatments for pain management. However, for any of these treatments to reach their full potential in terms of effectiveness, caretakers must be thoroughly educated in these areas and must be provided the tools and resources necessary to implement such programs by the nursing home’s owners and operators. For this and for many other reasons stressed in the series of articles published in this nursing home and elder abuse blog, It is critical for you to ensure that your loved one’s care facility is adequately staffed and that your loved one is being properly cared for by a knowledgeable and well trained staff. If you watch your loved ones like a hawk, you will instinctively know when a facility is not only understaffed, but also undertrained and not properly supplied with the resources it needs.

Malnutrition also factors in to the causes of agitation. A lack in nutrients can cause visual and oratory problems that may hinder the ability to see or hear and consequently increase the risk of agitation. Additionally, studies have proven that there is little evidence to support that the use of feeding tubes helps to improve nutrition in elderly adults.

A final common cause of agitation is delirium. It is often a consequence of polypharmacy, which is the excessive use of multiple prescribed drugs simultaneously. Since the use of drugs is a direct cause of delirium, and thus agitation as well, it is only logical to conclude that agitation should not be treated by using additional drugs. Specialists confirm that the best treatment for agitation is behavioral, not chemical.

However, some nursing homes may not have your loved one’s best interest at heart. Such facilities may be using drugs such as antipsychotics to chemically restrain elderly adults who suffer from agitation in order to subdue them and make them easier to handle. Furthermore, evidence has shown that use of antipsychotics may increase the risk of falls, mortality, and hip fractures. Not only is this is a direct violation of your loved one’s Patients’ Rights, but it can also be detrimental to his or her physical and mental well-being.