Trends in Long-Term Care - U.S. Senate Special Committee on Aging

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I would like to start with a summary statement. I th<strong>in</strong>k, even count<strong>in</strong>g
the advanced age, the chronic disease many of them have suffered
from, <strong>in</strong> a state of disrepair of many of these patients. <strong>in</strong>dicates an
<strong>in</strong>adequate care froni those who care for themi.
There is a high frequency of severe problems that is directly related
to nurs<strong>in</strong>g care. Some of the patients from nurs<strong>in</strong>g homes were so
severely dehydrated, as to be <strong>in</strong> a state of shock.
Some of these patients were so dehydrated, they could not salivate
or sweat.
Occasionally we would f<strong>in</strong>d dry food, and unswallowed pills <strong>in</strong> their
mouths. I could go on.
Many of these patients have severe decubitus ulcers, and other forms
of bedsores which are <strong>in</strong>fected, which may lead to <strong>in</strong>fection of the
underly<strong>in</strong>g bone, which may lead to generalized bloodstream <strong>in</strong>fection
and death.
In fact, the experience is so common <strong>in</strong> the hospitals <strong>in</strong> New York,
<strong>in</strong> the jargon of hospitals if you mention to a colleague that a new
arrival is a nurs<strong>in</strong>g home patient, it means he is a comatose patient
who has bedsores, is dehydrated, and has pneumonia or ur<strong>in</strong>ary tract
<strong>in</strong>fection. Patients <strong>in</strong> this condition are by no means rare <strong>in</strong> our
hospitals.
I have seen them steadily <strong>in</strong> my 21/2 years when I served as a house
officer <strong>in</strong> New York. Interns <strong>in</strong> hospitals all over the city have had
the same experiences which I have had.
I picked three cases-recently admitted to the hospital-to illustrate
the conditions I am describ<strong>in</strong>g.
We will start with Mrs. X. She is an 83-year-old lady who suffered
a stroke <strong>in</strong> 1972, was hospitalized for a period of time, and discharged
at home.
In 1973, she fell at home, she fractured her hip, was hospitalized
for surgery, subsequently was transferred to a nurs<strong>in</strong>g home, apparently
she had bedsores.
This past month she was sent back to the hospital. On admission,
she was unresponsive, she had fever, she was found to have warm and
extremely dry sk<strong>in</strong>, and <strong>in</strong> general massively dehydrated.
She had two areas of bedsores, one on the left, extended down
through the sk<strong>in</strong> to the underly<strong>in</strong>g bone.
The patient's blood count chemistry on admission showed evidence
of dehydration and concentration of the blood <strong>in</strong> a dangerous state.
The values for the blood nitrogen, which is a key <strong>in</strong>dex for a state
of hydration and kidney function, was a threefold to sixfold <strong>in</strong>crease
above normal. This was due only to dehydration and not at all from
kidney disease.
Because of 4 days of fluid and <strong>in</strong>travenous fluid treatment <strong>in</strong> the
hospital, this problem returned to normal.
This problem was fairly rapidly resolved, however, the bedsores
healed very slowly, and she was <strong>in</strong> the hospital for almost a month to
treat this condition.
Mrs. Y, an 89-year-old lady sent from a nurs<strong>in</strong>g home with poor
oral <strong>in</strong>take for several months, the note said the patient appeared to
be dehydrated.
Indeed, she was severely dehydrated. In this case the blood value
I just described <strong>in</strong> the other patient was 21 times normal, massively