Bicyclist, 74, killed in South End collision

Early-morning solar glare may have been factor

A 74-year-old bicyclist was killed yesterday morning in a collision with a car near the corner of Tremont and Arlington streets in Boston, according to authorities.

Police did not release the man’s name yesterday nor the cause of the crash, which happened at 8:10 a.m in busy South End traffic.

But it occurred at a time when solar glare can cause problems for drivers turning east on Herald Street. The white sedan involved in the crash was facing that direction.

The front windshield on the driver’s side was smashed and a U-shaped lock, commonly used to lock bicycles to poles or stands, remained in the snow yesterday morning alongside a piece of the car’s front bumper. The driver was interviewed by police and was not cited yesterday.

“It is sad to get such a vivid reminder that despite the good progress our city has made on bicycle safety in recent years, crashes like this can still happen,’’ said Pete Stidman, director of the Boston Cyclists Union, which advocates for rider safety.

Including yesterday’s accident, there have been at least three fatal bicycle accidents in the city in the past two years and several cases in which cyclists were left in critical or serious condition.

Nicole Freedman, the city’s director of bicycle programs, conducted a survey in 2009 in which 1,440 bicyclists said they had been involved in a cycling mishap in Boston dating back to 2005. Of that total, 37 percent said they were involved in an accident that included a vehicle, she said.

The survey identified Massachusetts and Commonwealth Avenues as the two roads in the city with the highest number of bicycling accidents.

Last August, a 24-year-old woman was struck by a car and killed as she rode on Commonwealth Avenue in Brighton. The driver was not cited.

And last April, a 22-year-old man was killed by an MBTA bus while riding his bike on Huntington Avenue. A day later, a 37-year-old man on his bicycle was hit by a car and seriously injured at the edge of Boston Common.

In both of those fatal accidents, the bicyclists were not wearing helmets. It was unclear whether the man killed yesterday was wearing a helmet.

Last October, a 65-year-old Jamaica Plain man was struck by a van as he rode his bicycle on Jamaica Way. He was dragged under the vehicle for about 200 feet before he was dislodged. The cyclist suffered numerous broken ribs, a punctured lung, and severe road rash that left him in critical condition.

Groups that advocate for safer bicycling conditions in the city have called for lower speed limits, improved bike paths, and more programs to educate drivers on how to share the road.

Mayor Thomas M. Menino hosted two bicycle safety summits last year, and Freedman’s office is currently analyzing information from cyclists, officials, and highway and road experts who attended.

Stidman said he recently was hit by a car on Dorchester Avenue, but was unscathed. He said it is important for cyclists to report such accidents.

“I talk to cyclists all the time and remind them to report to police or the city whenever they’re involved in an accident because we need to know where the accidents are happening in order to fix the problem,’’ he said.


Nursing Home Negligence

Falls in Nursing Homes

Litigators who work with cases involving long term care know how significant the issue of falls can be. Falls are the leading cause of injury and death by injury in adults over 65. Approximately half of the 1.6 million nursing home residents in the U.S. fall each year, and a report by the Office of the Inspector General found that about 10% of Medicare skilled nursing residents experience a fall resulting in significant injury; and, more than 1/3 of hospital falls result in injury. In the rehab setting, rates are often higher – for example, fall rates among stroke patients have been shown to be very high. Immobility and falls can lead to poor outcomes.

Fear of falling is defined as a geriatric syndrome. It not only occurs in older adults who have fallen, but in those with impaired mobility and is associated with decreased physical ability and depression. Care of older adults requires that clinicians be aware of the myriad of issues related to falls including knowledge of this syndrome, increased risk and interventions needed to prevent injury related to falls.

Just about every resident in a long term care setting, including assisted living and sub-acute rehab, is at risk for falling. Between medications, functional and medical issues and advancing age, older adults in most settings are prone to falling.

There are well established standards of care related to fall prevention; but, as I continue to review records related to issues like falls, I am amazed at how often these basic standards are not being practiced. The basics of a fall prevention program include assessment and ongoing reassessment of risk, ensuring a safe environment, medication review, providing therapy as needed, individualized interventions, and staff education.

Basic nursing practice includes assessment, planning (Care plan), putting interventions in place and then evaluating outcomes to determine if those interventions are appropriate and effective. Assessment includes completing fall risk assessments on admission and then as needed. Very often, the fall risk assessments completed by nurses in LTC are inaccurate. The tools utilized in long term care typically include these risk factors: history of falling, use of ambulatory aids, gait/balance issues, medications, secondary diagnoses (i.e. diabetes) and mental status. Care planning is the next step in nursing care - it is the standard of care that as the resident’s status changes, assessments and care plans must be updated, and often, are not. For example, with each fall, there should be updates, or if there is a new diagnosis, i.e. stroke, or worsening dementia, updated interventions should be put into place, with ongoing evaluation of effectiveness.

Care planning and interventions very often are generic and not individualized. For example, a toileting schedule that includes only after meals and before bedtime may not be appropriate. If a resident has issues with constipation or incontinence, this may lead to the need for more frequent toileting to prevent falls. The “make certain call bell is within reach” for residents with dementia is an example of a generic intervention. Older adults with dementia may not recognize a call bell or remember to use it. The debate about use of bed and chair alarms go on – they are a part of an individualized care plan, not a solution to preventing falls. Often, I see delays in putting interventions in place, i.e. with the resident who is incontinent NOT being put on a toileting plan immediately. The other common issue I see when reviewing records is the lack of updating care plans as the resident’s status changes – with every fall, with worsening dementia, physical decline, or new medical diagnosis (i.e. Parkinsonism).

Nurses reviewing records need to pay attention to the MDS, risk assessments, care plans and Interdisciplinary notes with attention to where the standard of care is not being met.
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7 days ago  ·  

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