The patient, a resident at Sunrise Senior Living in Haverford, Pennsylvania, had told family members that workers at the facility were abusing her. According to the family, they received no help from the facility, so they set up a hidden camera to find out what was going on.

The video shows the victim being repeatedly beaten, workers removing her clothes and leaving her half-naked, and trying to remove her jewelry. The workers are accused of punching, kicking, stripping and poking the patient in the eye.

Samirah Traynnham was arrested on charges of aggravated assault, simple assault, criminal conspiracy, neglect and endangerment in the case, and Tyrinna Griffin, was arrested on suspicion of abuse.

The workers variously claimed that their actions were just a “joke” and that they never “purposely” struck the patient.

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In particular, those facing life-ending illnesses such as cancer, heart failure and dementia, are subjected to drawn-out procedures that may be counter-productive and create a miserable environment for patients in their final days. Consider:

• Hospitalizations during the last six months of life increased by more than 10% between 1996 and 2005.
• Average time spent in hospice care or other palliative treatment is shorter, because patients are getting aggressive treatment up until the very end. (One-third of hospice patients received it for less than one week, according to one study.)
• As many as 20% of cancer patients receive four or more sequential treatments of chemotherapy, even though  guidelines call for no more than three attempts if the tumors haven’t responded to treatment.

The reasons for this over-treatment are complex – but understandable.

Many doctors practice “exhaustion medicine” – trying any treatment regardless of likelihood of its success, until there are no options left. Doctors may revert to this out of a fear of lawsuits later on, or simply because it’s difficult to convince a patient in denial that his or her condition is simply not treatable and won’t improve.

Doctors don’t share all the blame for overtreatment. Patients may have little to hold on to besides the hope of getting better – and if a treatment has only a 1% chance of working, that 1% chance may seem preferable to waiting for death.

But overtreatment has numerous downsides: It not only saps the sorely needed resources of an already-strained health care system, it subjects patients and their families to unnecessary pain and discomfort – both physical and emotional.

Ethics experts and others in hospice and palliative care urge health care providers to make time with patients, especially those diagnosed with cancer, dementia and heart failure, to discuss the true pros and cons of aggressive treatment past a certain point. The earlier, the better.

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The alert points out that 25% of suicides reported took place in non-psychiatric settings. Many of the patients who committed suicide had no history of psychiatric problems or suicidal attempts.

Risk factors for these patients include dementia, traumatic brain injury, chronic pain, intense acute pain, substance abuse, a poor prognosis or terminal diagnosis.

The alert urges health care providers to be more vigilant about the risk of suicide in these patients and to educate caregivers on warning signs of suicidal attempts.

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Still poorly understood, hospital delirium is being seen (or, perhaps is now more likely to be recognized) in patients. Patients experiencing delirium are often reluctant to discuss it, but have described terrifying scenarios, intense anxiety, disorientation and a feeling that they need to escape the hospital. It’s more common than many health care providers realize — up to one-third of patients over the age of 70 experience it.

And while it was once believed to be a temporary, if unpleasant, occurrence, doctors have found that delirium patients have more complications and generally poorer long-term prognoses.

Contrary to conventional wisdom, the patients most at risk aren’t limited to those who already have dementia. Risk factors/triggers include: recent surgery, invasive procedures such as catherization, pneumonia and infection. Some medications, especially sleep aids and those which are poorly metabolized by geriatric patients, have been associated with the syndrome.

The condition can be exacerbated by some of the common patient complaints of hospitalization: constant interruptions that keep patients from sleeping, not having needed eyeglasses/hearing aids with them, changing rooms, losing their daily routine, limited social contact, etc.

The long-term consequences are troubling: Patients with hospital delirium may have needed treatments delayed due to the condition, face more complications, are more likely to later develop dementia, and have higher death rates. It’s believed the delirium puts the patient in a more fragile state that makes other complications more likely.

Prevention programs that keep patients on a daily routine, ensure they have glasses and hearing aids and monitor medications more closely have had some success in reducing the rates of hospital delirium.

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Avid Radiopharmaceuticals, a Philadelphia-based company has developed a dye that allows doctors to see the plaques forming in the brains of Alzheimer’s patients.

The research will be presented next month at the Alzheimer’s Association international meeting. And the test still has to be approved by the FDA.

But if it makes it through that process, it’ll be the first test that allows doctors to confirm an Alzheimer’s diagnoses without a postmortem brain biopsy. (Currently, 20% of dementia patients diagnosed with Alzheimer’s have been found to not have the disease after the brain biopsy is performed.)

It’ll also provide researchers with better information on the effectiveness of drugs and other therapies used to treat the disease.

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The service comes with a live “dashboard” that allows staff to track the location of the wearer of the device. That’s especially crucial for the elderly and dementia patients who may be on strict medication timetables.

Is this a useful tool, or another example of Big Brother? Weigh in in the comments.

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Andres Cardona, a 72-year-old dementia patient at Columbus Park Nursing & Rehabilitation Center near Chicago, saw a plate of pot roast in a neighboring room,  and decided to help himself.

Unfortunately, the room’s occupant was 62-year-old Ardyce Nauden, who’d done prison time and had been previously classified as a “psychotic felon.” Nauden wasted no time defending his turf, beating Cardona with punches to the head. Cardona subsequently died from his injuries.

Nauden now faces first-degree murder charges.

According to the local press, this was merely the worst case of several recent violent incidents at Columbus Park.

Geriatric care facilities face a heavy burden providing day-to-day care for patients and residents. When dementia sufferers are placed in close proximity to other patients, tensions can quickly escalate from the mundane to murder. There’s no question that facilities have to make trade-offs between security and freedom — but few would advocate a lockdown-style facility for the most vulnerable patients.

What’s the balance between providing good care and good security? Share your thoughts in the comments.

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A 100-year-old woman was allegedly strangled by her roommate at a nursing center — just steps from the nurses’ station. Could staff have prevented it?

A heartbreaking crime in Massachusetts is shedding new light on a problem front-line staff are all-too familiar with: Violent, disruptive behavior in nursing homes and geriatric care wards.

Elizabeth Barrow, 100, was found strangled and suffocated with a plastic bag tied over her head at Brandon Woods Nursing Home in Dartmouth, MA.

Her roommate, 98-year-old Laura Lundquist, has been charged with second-degree murder. Because Lundquist has a long-standing diagnosis of dementia, the prosecutors and defense attorney have jointly requested a competency hearing for Lundquist.

A trial is possible, but not likely, given Lundquist’s age and health.

Whatever the legal outcome may be, there are sure to be questions about how this could have happened in a facility that provided 24-hour monitoring.

History of conflict — and violence

Staff at the nursing home said that Barrow never claimed to feel threatened. But there was a history of conflict between the two, who had been roommates for just over a year in a tiny, 420-square-foot room.

Lundquist had made many comments about Barrow trying to “take over” the room, and had exhibited other erratic behavior, including saying that a prior roommate had tried to strangle her in bed. She also said that she would get Barrow’s coveted window-side bed, because she was going to outlive her.

In July and August, staff were concerned enough about the situation to offer the women new room assignments.

The night before Barrow’s murder: The women argued over a table Lundquist placed near Barrow’s bed, limiting Barrow’s access to the bathroom. When a nurse’s aide moved it, Lundquist physically attacked her.

But nursing staff didn’t separate the women. The next morning, nurses saw Barrow get up to use the bathroom at about 6 a.m. At 6:20 a.m., a nursing assistant found Barrow dead with the sheet pulled over her face and a plastic bag tied around her head.

Challenges of geriatric care increasing

Besides the usual interpersonal conflicts that arise whenever people have to share space, dementia and other ailments can lead patients or residents to exhibit behavior far removed from their usual character.

And staff may have trouble determining which arguments are just sniping that will blow over by dinner and which will escalate to violence — or even murder. Facilities with space limitations can’t always play it safe by separating patients.

Some strategies that help:

• Have single rooms or other back-up quarters always available so that if an emergency situation arises, staff can take action.
• Retrain staffers frequently on communication techniques specifically for working with geriatric patients, especially those with dementia or similar conditions.
• Remind all employees to be on the watch for personality or behavioral changes that may be red flags of a deteriorating mental state or impending violence.
• Keep patients’ families as well as treating physicians alert to observed behavior to better identify when a patient seems to be undergoing a change in personality.

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