TBIs from Minor Falls in Nursing Homes
A small fall might seem harmless, but in nursing homes, it can lead to traumatic brain injuries that change lives forever. In this week’s episode, nursing home abuse lawyer Rob Schenk talks with guest Kalliope Panagos about why minor falls can be so dangerous, how TBIs are often missed, and what families can do to protect residents.
Panagos:
If you move their arms and they grimace, if they’re nonverbal things to look for is you look at the facial expression and if they’re in any pain. So mostly nonverbal. You need to look at the physical symptoms. But when they’re verbal, then they’ll tell you, yeah, I had a fall. I hit my head at that point. You do everything from head to toe.
Intro
Schenk:
Hey, out there. Welcome back to the Nursing Home Abuse podcast. My name is Rob. I will be your host for this episode. We’re talking about traumatic brain injuries in nursing homes the signs and symptoms and what we can do to prevent them. But we’re not having that conversation alone. We have Calliope Pinus joining us to take us through this subject.
We are talking about TBIs in nursing homes. We’re not doing that alone. We have Calliope PGAs. Calliope is the founder of Zoe Legal Nurse Consulting with over a decade of hands-on nursing experience from long-term care to case management. Calliope brings a deep understanding of patient care and health and the healthcare system.
Her passion for advocacy led her to legal nurse consulting where she helps attorneys. Analyze medical records and uncover the truth in nursing home and personal injury cases. Inspired by her Greek heritage, she named her company Zoe, meaning life and lives out its mission, bringing justice to life, and I’m so happy that she’s bringing this topic to life for us today.
Calliope, welcome to the show.
Panagos:
Thank you for having me.
What constitutes a TBI?
Schenk:
I think to just so that we are all on the same sheet of music, I think the first question is gonna be what constitutes a traumatic brain injury?
Panagos:
So that’s a great question. Traumatic brain injury is basically, it happens when an external force injures the brain, which causes the brain to not function normally.
There are two parts of a brain injury. There’s a close head injury and there’s a penetrating head injury. So the close head injury for an example, is in this case a fall or a blow to the head, or a penetrating injury, which is a gunshot wound.
This article examines the role of nursing staff in managing head trauma on the impact of preventive health measures in elderly populations.
Schenk:
And you said it’s close. And then, what was the other one?
Panagos:
Penetrating.
How can minor falls in nursing homes lead to traumatic brain injuries (TBIs)?
Schenk:
Penetrating, okay. I guess so for, and oftentimes for our purposes in long-term care, we’re dealing mostly with closed closed TBIs, right? Yes. Like for somebody hits their head on the ground. Okay. So tell me then. How is it? Because I’m sure there’s a lot of people that can, that, that it’s hard to understand how someone barely hitting the ground with their head, how that could possibly cause a traumatic brain injury.
Panagos:
So see, if it’s people my age that has a fall, no big deal. But if it’s an elderly person, their blood vessels are more delicate. A lot of them are on blood thinners. So a slight little head bump can be a life-threatening somatic brain injury.
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What are the early signs of a TBI that caregivers should watch for?
Schenk:
Okay. Then if that’s the case, then let’s say that we were at a nursing home, someone has fallen, but perhaps we didn’t see the fall. So it’s a, it’s an UNT fall. What are some of the indicators that this individual has?
Panagos:
A traumatic brain injury, increased confusion on steadiness on their feet upon standing. And also very difficult for them to respond to questions timely like they used to. They don’t seem fine when they were okay before.
Now they seem off. They were normal before and then they just seem off and, usually you just have to take that as a red flag.
This study highlights fall-related injury patterns in residential care on the impact of preventive health measures in elderly populations.
Why do some head injuries in elderly residents go undiagnosed?
Schenk:
I guess would it, should it be the case then that if it’s unwitnessed, is the default to just assume in situations where the baseline is confusion and it would be difficult to parse through whether or not they have the signs and symptoms of TBI versus this is just, they’re being this, their normal self to treat it every fall like that as a as though it’s a potential TBI.
Panagos:
Absolutely. It is very important. It is a critical issue because falls are preventable and they have to do neuro checks for the first 15 minutes of the fall. Just assume that they hit their head even if they tell you that they’re fine. Even if they were confused before, you still have to assume that they hit their head and really be diligent and be mindful of anything that’s changed since their fall.
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Schenk:
Walk us through what a typical neuro check is.
Panagos:
So neural checks happen. Been I can just tell you that the first 50 it’s every 50 minutes for the first hour. Every 30 minutes for the next four hours, every hour for the next 24 hours, and then every 70 for the next 72 hours, it’s every four hours.
Schenk:
I see. So with the neuro check, is it gonna be something along the lines of you’re looking at dilation of the pupils? Is it like is it what you said? It includes behavior, things like that.
Panagos:
Yeah. So dilation of pupils, vital signs, pain, nausea, vomiting it would be also motor function. Things like that. Okay.
Schenk:
I see. So the, I, I guess from my perspective, the way I think of it as a neuro check is only cognitive, but it’s other things too. So it’s, I guess it’s the things that kind of expand out from the cognitive, like being able to your motor functions as you mentioned behavioral changes and that kind of stuff. So that’s happening. You said every 15 minutes for the first hour?
Panagos:
Yes.
What role does proper assessment play after a resident experiences a fall?
Schenk:
I see. And what role does that assessment play in preventing TBIs or reducing them?
Panagos:
I would say because it allows you to catch things early on, and a lot of the times traumatic brain injury are not very obvious until the next 72 hours. So it really keeps it on track in terms of staying on top of it and being diligent with the assessment. So that if you do see any kind of change from the baseline. To get immediate medical care right away.
Analysis of trauma complications in older adults is available on the impact of preventive health measures in elderly populations.
Schenk:
And so what happens if there is no care? Let’s say that they, that this individual that has fallen has a TBI but slips through the cracks for whatever reason. What are the, what can we expect to have happened?
Panagos:
Increased confusion, difficulty with arousal and then they start getting agitated when they were really sweet before. And they just seem off. And if they seem off to you, then they are off.
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What long-term effects can undiagnosed TBIs have on elderly residents?
Schenk:
And then take us through the long term. Is it, like essentially the A TBI like your, it’s your brain. Your brain is bleeding. What’s going on, like long term, what’s happening to this person that’s not treated?
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Panagos:
It’s extremely devastating, honestly. One of the physical, and they go through physical changes, emotional changes accelerated cognitive decline, which then becomes full-blown dementia at that point.
They can also end up being very depressed and agitated because. When they used to be able to be independent with their activities that they used to do. Now they are no longer independent. Now they’re dependent on their caregivers, which is very frustrating to them. So it affects them mentally. They get depressed.
If your loved one suffered brain trauma while in care, consult a nursing home abuse lawyer for head trauma cases.
They’re more, sometimes they could become impulsive with decision-making. In terms of swallowing too, that also affects their swallowing, which then can cause pneumonia because they can choke and the food can go in their lungs. So it has a whole. Plethora of things that can happen, and it’s extremely devastating.
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Schenk:
I see. So it’s, it’s not lethal. This is a condition that you live with.
Panagos:
Yes. If it’s not cared for properly on time, then Absolutely.
How can nursing homes improve fall prevention to reduce TBIs?
Schenk:
I see. And so what are some of the ways that a nursing home can essentially prevent or reduce TBIs from falls?
Panagos:
What they can do. This is actually a really critical issue because one of the big things with nursing homes is staffing.
So a lot of the times I’ve had something happen where I was doing Med Pass and I had 30 patients under me, and I didn’t see the patient on the floor until I went in the room to give her meds. She was very nonverbal. She was just laying there next to her bed. So I found her right away. I got, I became really diligent.
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I sent her out, got a CT scan of her head because she had blood thinners. She was taking blood thinners, which you have to make sure. And everything was fine, thank god. But more training proper body mechanics with transfers, especially with the bed being high up. Not slip fulls free of clutter, lit.
Always do physical and occupational therapy to make sure that they can have some strength training. To help with the weakness at the experience at their age, but I feel like staffing is a really big thing. This is why a lot of these accidents happen.
In Episode 42: How Nursing Homes Can Be Liable for Injuries from Falls, we discuss when facilities can be held accountable.
Schenk:
So it’s unfortunately expand on that.
Like why is staffing important? What is having less staffing doing that would cause more residents to have falls related or, and causing TBIs.
Panagos:
Because they have 30 patients under them, so it’s hard to keep an eye on all of ’em. And a lot of these residents have agitation. They walk around and you don’t even notice that they’re walking around because you’re busy doing other things or, 30 patients. That’s a lot.
Episode 141: Reducing Injury from Nursing Home Falls outlines actionable strategies for prevention.
Schenk:
So in that example that you gave about finding the resident, you said you found her on the ground by her bed. Yes. What do you do at that point?
What’s your process like? Do you do an assessment of her physical body? Do you, are you asking her questions? Walk us through what your assessment was?
Panagos:
If they’re not nonverbal, you don’t really ask them. So really look at the physical aspects. If they, if you check their eyes, make sure that their pupils, if it’s more than half a second.
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Of the pupils reacting to light, that means that sluggish, and that’s a red flag. Also you got, you can also check for any bumps on the head. You can feel around if they’re vomiting. If you move their arms and they grimace, if they’re nonverbal things to look for is you look at the facial expression and if they’re in any pain.
So mostly nonverbal. You need to look at the physical. Symptoms. But when they’re verbal, then they’ll tell you, yeah, I had a fall, I hit my head. At that point. You do everything from head to toe.
Learn how to evaluate fall risk using MDS assessments in Key MDS Data to Identify Fall Risk in Nursing Homes.
Schenk:
Lemme ask this for that example that you gave where you did the assessment and sent the resident out for a CT scan what, like how do you know? When to do that versus when to just wait for the next neuro check. What is the red flag? It’s okay, let’s go ahead and send her out rather than do more neuro checks.
Panagos:
I’m a little OCD to be honest, when I know that someone’s on multiple blood thinners. I’d rather just be safe than sorry. I see. That’s just my, that’s just the way I do things.
You could just never, because, plus being delicate with their blood vessels, being older, even a slight little blow can move their brain around in their skull and that can cause a bleed, so I’m very, especially, I don’t even know if she’s hit their head. I just rather be on the safe side.
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How can families ensure their loved ones receive proper evaluation after a fall?
Schenk:
That makes a lot of sense. What, are there any anything that you can say to a family that has a loved one in a nursing home that might have the the, that might be at risk for a fall? What you can educate them about in terms of be on the, being on the lookout for TBIs. What advice would you give for those family members?
Panagos:
The first thing that they should do is ask detailed questions such as, did anyone witness this fall? Was their head impacted in any way? Could it have been? What symptoms have they shown since the fall? Has anything changed? Are they more confused than before?
And just, if the nursing home tells ’em, oh, they’re just fine. They’re just, it’s just their age. I feel like that’s a red flag and they need to push and be persistent. They need to just keep on pushing and probing, get as much as information as they can since the fall. And also teach the family about, ways to prevent falls.
Proper body mechanics. Ensure that they have not skid footwear, not socks, especially when they shuffle around when they’re older. Socks is not really a safe thing. Gym shoes or tennis shoes is really good. And just overall, just keep an eye on how the mood. Shifts from what they were before the fall.
Episode 131: Interventions for Fall Risk Prevention in Nursing Homes offers proactive solutions for long-term care staff and families.
Schenk:
Very well said. Kpi, thank you so much for for coming on the show and sharing your knowledge with us.
Panagos:
I appreciate you having me,
Schenk:
Folks. I hope you found this episode educational. If you have an idea for a topic that you would like for me to talk about, please let me know. If you have an idea for a guest that you’d like for me to talk to, please let me know that as well.
As always, please. Take one of these mugs from me. I beg you new episodes in the Nursing Home Abuse podcast. Come out every single Monday. And with that, we’ll see you next time.
Kalliope Panagos’ Contact Information: