Spinal Injuries

Broken Back and Spine Fractures in Nursing Home Patients

While estimates vary, studies show nearly 50% of nursing home patients fall each year, and many of them sustain fractures of some kind. Some, though not many, even die.

Causes of a Spine Fracture

While a patient can suffer from a broken back fairly easily (from any kind of fall), there are some especially common accident types:

  • Car accidents (whether the patient was driving or not), even mild ones
  • Dropped while moving in/out of bed or chairs by caregivers
  • Slips (water on floor, icy sidewalks, etc.)
  • Trip hazards
  • Poor vision, making hazards even harder to detect
  • Losing balance in the shower or tub
  • Complications from underlying medical issues
  • Past implant malfunction (for instance, hip replacements), resulting in falls

What Will the Nursing Home Do?

Nursing homes should have a detailed protocol in place for handling broken backs. Most employees are trained to call an ambulance and administer basic first aid as needed; others, depending on the facility, are trained in securing patients to backboards before the ambulance arrives, though this is rare.

Once in the hospital, the patient’s care is passed to the doctor or doctors treating them. The nursing home should file an accident report that’s as detailed as possible.

When the patient has recovered completely, he or she will be transferred back to the nursing home. If special aftercare is required for a broken back or other fracture, the home should accommodate.

Spinal Cord Injuries

When the spinal cord is damaged with a broken back or trauma, paralysis occurs. Other neurological conditions may develop, as well.

Nursing homes should assume the patient has a spinal cord injury, even if they don’t, and treat them accordingly. Unless they are trained to do so, no employees should reposition the patient’s neck or straighten their spine in any way until help arrives, to avoid worsening the possible injury.

Talking through the Taboo

Your loved one may be reluctant to admit he or she has fallen, whether witnesses were present or not.

Encourage your loved one to be open and honest about his or her health, and make sure they know there’s nothing to be embarrassed about. Everyone falls–older people just tend to fall more often.

Risk Factors

Several factors can increase an elderly patient’s risk of sustaining a fracture:

  • Osteoporosis
  • Being female and postmenopausal
  • Being Caucasian or Asian
  • Having a small and slender frame
  • A history of malnutrition, especially in childhood, or a history of eating disorders
  • Smoking (past or present)
  • Alcoholism (past or present)
  • Nervous system disorders such as Parkinson’s disease
  • Diabetes
  • Other disorders that can affect muscles, bones, nutrition, balance, etc.

There are also specific risk factors for sustaining a broken back:

  • A history of spine fractures
  • A history of hip or pelvic fractures
  • Hip or leg replacement or prosthetic use
  • Refusal or inability to complete physical therapy (or past or current injuries)
  • History of scoliosis, especially in adolescence
  • Individual is quite tall (even if they are in a wheelchair now, or hunched over when standing)
  • Individual is usually bed-bound or rarely gets up

Prognosis for Patients

While many broken back patients can and do recover, it is important for family, friends, and the patient themselves to acknowledge limitations. Patients may no longer be able to move or walk; some will have the same abilities as before, but decreased (for instance, the ability to go upstairs, but less often).

As for long-term outlooks, a few will heal and go on with their lives normally. Most, however, face an increased risk of death from complications, other injuries, or decreased mobility.

A retrospective study of 640 patients from 1991 to 2006 (at two long-term care facilities) revealed 19% of elderly adults who sustain spinal fractures will die within three months; 28%, within a year.

Obviously, the younger the patient (between 65 and 75, roughly), the greater their chances of recovery, and the lower their mortality rate.

 

Sources Cited:

Huffington Post, “If My Mother Died Today.” http://www.huffingtonpost.com/elaine-ambrose/caring-for-elderly-parents_b_5979904.html

The Journal of Bone and Joint Surgery, “Mortality in Elderly Patients After Cervical Spine Fractures.” http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2827825/

Apparelyzed, “A Broken Back–What Happens?” http://www.apparelyzed.com/broken-back.html

Merck Manual, Consumer Version, “Falls in the Elderly.” https://www.merckmanuals.com/home/older-people-s-health-issues/falls/falls-in-the-elderly

A Place for Mom, “Elderly Hip Fracture: Prevention and Treatment.” http://www.aplaceformom.com/senior-care-resources/articles/hip-fractures-in-the-elderly

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