Orthostatic hypotension: The often missed answer to the question of why a nursing home resident fell
Posted: Tuesday, June 5th 2007
Unfortunately, it's a fact pattern that those of us who prosecute nursing home neglect cases hear all too often. It goes like this:
"My mother got out of a chair and took two steps and collapsed. She broke her hip. The nursing home said people like my mother fall a lot and there's nothing they can do to prevent the falls. After all, they don't want to restrain mom to a bed."
Medication Administrator Records (often referred to in the nursing home chart as "MARS") are a good place to look for clues about what is causing a resident to fall.
Nursing home residents are often given psychotropic drugs. Occasionally, these drugs are warranted based on resident's underlying disease process or mental state. However, sometimes it's been alleged that these drugs make it easier for a nursing home to use fewer paid staff members to "monitor" residents. After all, if Grandma cannot get out of bed, because a drug has zapped all her energy, she cannot elope from the facility.
The administration of psychotropic drugs is causally linked to a condition called orthostatic hypotension: a temporary decrease in blood pressure. This decrease in blood pressure can cause lightheadedness, dizziness and fainting. This condition is directly related to falls. Nursing home residents are believed to be more susceptible to orthostatic hypotension caused falls because the average resident has other ongoing disease processes. The resident with an orthostatic hypotension condition can feel fine while sitting or at rest. But just a few steps into a walk she may collapse and fall. This is a common phenomenon. It's also preventable.
There are procedures for nursing homes to assess residents at risk for orthostatic hypotension caused falls. One of the simpler methods is to take a resident's blood pressure while the resident is sitting or resting and then have the resident stand (with assistance nearby if needed) for a minute or two and then take another blood pressure reading to see if the pressure has dropped significantly.
All a nursing home has to do to prevent most falls related to orthostatic hypotension is to:
- Identify at risk residents, largely through examination of the MARS, but also based on prior behavior and vital signs sheets;
- Periodically examine the resident for signs of orthostatic hypotension; and
- Use proper interventions with residents who are at risk.
The preventative measures all require staff time. Staff time means increased labor costs and decreased corporate profits. That's why the preventative measures often are not done. That's why many residents are subjected to falls caused by orthostatic hypotension. That's why I choose to prosecute nursing home cases.
For additional research please read the following:
- "The association between orthostatic hypotension and recurrent falls in nursing home residents." AM.J.Med. 2000 Feb; 108(2):106-11.
- "Orthostatic hypotension in the nursing home setting." J.Am.Med.Dir.Assoc. 2006 Mar;7(3);163-7.
- Appropriate Use of Psychotropic Drugs in Nursing Homes - AAFP.org
- Annals of Long Term Care - Clinical Journal of the American Geriatrics Society