Unnatural Deaths in Nursing Home Patients

Abstract

Nursing home residents comprise a large and rapidly growing segment of the national population. Despite this fact, the majority of deaths occurring in nursing homes are not investigated because of the significant medical illnesses suffered by most residents. Herein, we report a series of unnatural deaths in nursing home residents, including two homicides and seven accidental deaths. In four of the deaths, there was an attempted concealment of the cause and manner of death. Fearing criminal or civil proceedings, nursing home personnel may attempt to conceal homicidal or accidental deaths in nursing home residents. Because of the serious, chronic illnesses suffered by these patients, attending physicians are often willing to sign death certificates without personally investigating the circumstances surrounding the patient's demise. The authors contend that unnatural deaths of nursing home patients are significantly underreported. Attending physicians and death investigators should be urged to investigate more fully sudden deaths in nursing home patients.

Fatalities related to medical restraint devices—Asphyxia is a common finding

“…Quite a number of group I cases (strangulation and asphyxia) including compression from bedrails and bars have been published [3][4][5]13,15,19,20,[22][23][24]27,28] but there are only few reports of group II (asphyxia from thoracic or abdominal compression) [15,22]. This has led some authors [9,22] to the assumption that compression-induced stress-reactions, which are quite difficult to verify post-mortem, instead of asphyxia, are the major cause of death.…”

“…A protective cover (case 1) should never be (mis)utilized for restraint [15,22] and a waist belt requires the simultaneous use of bedrails and of the lateral fixations of the belt, which was not done in cases 2-4, 6 and 7. Such inadequate restraint techniques, which have been recorded in similar cases before [3,8,15,22,23], do not prevent a displacement of the patient's body. Consequently, prophylaxis is based on the proper use of restraint devices, on detailed instructions of the nursing personnel and also on close monitoring, especially in the presence of dementia or apractic disorders.…”

“…Ironically, this may be one reason why no consequences under criminal law were drawn. A substantial number of unreported cases is likely for the same reason [3,7,15,22,23]. The problem lies in the fact that it is easy to change the scene or conceal evidence.…”

“…As a consequence, cases of abuse and neglect of the elderly [1,3,11,12,18,25] are likely to increase in the future. Complications in elderly persons restrained by a medical device constitute a special subgroup.…”

“…Studies on the prevalence of restraint-related injuries have revealed only low rates of minor complications [26,29]. On the other hand, there are several reports of elderly fatalities where death occurred in a helpless situation while restrained by a medical device [3,4,5,15,[22][23][24]28]. A total of seven such cases is reported to demonstrate that these cases do not represent literary rarities and that a detailed death investigation can demonstrate findings indicative of local mechanical compression and/or asphyxia in just about all cases.…”