Really sad. MIL fell last night and broke her hip. Questions about recovery.

[Faith-manor]

I am very upset. She's 83 and a wonderful grandma to my kids. She tripped over a rug that we've taken up time and time again because it was a hazard for her, and she kept getting out again. It's a rag rug she made years ago. Her knees are stiff so she shuffles her feet and would catch her toes on that rug. She has fallen due to that rug before. I don't know why elderly folks have to be so stubborn.

She didn't do so well through the night. She has BP troubles, and kidney issues as well. The BP was hard to get down and keep down. It's more stable now. But she seems "off" to me, and the doctor isn't really very helpful. Dh has asked him what to expect, and they just rush around and shrug their shoulders.

If you've had an elder with this injury, can you post here? What was recovery like? Pain management? Did they go to rehab before coming home? Were  they able to walk? Should we worry about pneumonia? How much physical care did you need to provide and for how long? If they went to rehab, did you have to be there a lot, did they require lots of advocating or was it fairly straight forward?

Thanks to all who respond. I think I'll be at the hospital the whole day, and will try to check back on my cell phone.

[Ottakee]

One of the first things to check in an elderly patient who is "off" is bladder infection with culture.

Next I would look at her meds...esp the combo of her regular meds with any pain meds.

Are there any signs of a stroke?

Just being in the hospital itself can be very disorienting for seniors.

[Melissa in Australia]

huge hugs

 the stubborn ones are the ones that survive so long - the people with no will power don't last as long.

 

I don't have any helpful advice about broken hips. My grandmother is nearly 90- she has had 5 hip replacements or surgeries for the hip coming out of socket in the last 8 years.mostly because of falls. She always has a couple of weeks of rehab afterwards. she still walks but with a walking frame. She has had extensive training on falling carefully so she doesn't land on her hip.she has some muscle  condition where her muscles waste away and go slushy or tear very very easily - I don't know what the condition is called. but that is why she had to have some of the hip replacements multiple times .

 

[Jaybee]

Okay, so I don't have all the details, but roughly:  MIL fell and broke her hip (at maybe 6 years older than your MIL?). She had surgery, and then was taken to do rehab in a nursing home. She became depressed and was not cooperating very well with therapy. Finally, family decided to just bring her home, which made her much happier, and motivated her. She was able to walk pretty well with a walker before long. A year or so later, she fell again and broke a hip; I'm not sure if it was the same one or not. More surgery. Again in rehab. Same scenario in that she became uncooperative, but it took time to set things up at home because this time, she had to have in-home care. In the meantime, her feet began to become deformed. She is now at home, with 24 hr. care. She has to be lifted with a lift, have diapers changed, etc., though she feeds herself. But she is so much happier at home, even though she is wheelchair-bound, and doesn't complain. She has some memory/mild dementia issues going on, but seems pretty positive over all. While in the nursing home, she did have a bout or two with mild pneumonia. If I understand correctly, that is always a possible/probable issue. Personally, I have wondered if the nursing home personnel discounted her a little because of her age, and didn't encourage her/push her enough with the PT. I'm sure it is hard to know how much to push when the patient is in their 90s, but it makes me sad to see her feet all atrophied and twisted.

[Valley Girl]

2 hours ago, Ottakee said:

One of the first things to check in an elderly patient who is "off" is bladder infection with culture.

Next I would look at her meds...esp the combo of her regular meds with any pain meds.

Are there any signs of a stroke?

Just being in the hospital itself can be very disorienting for seniors.

Sorry about your MIL, Faith. Jumping off what Ottakee said, you might want to read up on something called hospital psychosis and keep the info in your  back pocket so to speak.  It's a condition that can develop in hospitalized patients. I had no idea it was a thing until my mom (in her 70s) experienced it while hospitalized. Best wishes.

[J-rap]

Sorry about that.  Yes, why are some elderly people so stubborn?  My father is like that.  

He broke his hip a year ago at the age of 90.  He was watering a plant outside and tripped and fell on the cement.  Thankfully a cousin happened to be driving by and thought my father was in a strange position while watering flowers, so he stopped!  He was in a rehab facility for about a month or so?  He couldn't drive for another couple months after that.  Eventually, he got back to where he was before, even caregiving for my mother again, in their own home.  He did very well with all of that!  We did change a few things in their home before he returned home -- getting a higher toilet seat with grab bars, adding more grab bars to their shower, removing rugs.  (He put some of them back!)

Now he has another completely unrelated problem developing that might not be so easy to fix, but he did have one good year in-between the hip surgery and this current problem.

 

[katilac]

It's usually a very tough recovery, I'm sorry to say, but there are specific things that can help. 

Avoiding confusion/delirium in the hospital is very important. Orient her often as to day, time, what's happened, and what will happen. Try to keep her up on a regular schedule (awake during the day, sleeping at night) so she has a better sense of time passing. Do not hesitate to wake her up, and preferably keep her awake as much as possible to begin with as opposed to letting her drift off and then waking her up. Make sure she has her glasses, hearing aids, whatever, even if it's meant to be a short stay. Bring some clothes that can go over her hospital gown - a cardigan during the day, button up pajama top at night (makes them feel better and also helps orientation).  Bring in as many visual cues as you can: if she usually has coffee in her favorite mug every morning, bring in that mug (putting it away when done). If she usually watches Jeopardy in the afternoon, turn it on. If she usually wears a bit of makeup or jewelry, help her put it on in the morning and take it off at night. Basically try to recreate the usual rhythm of her days. Getting her out of the room is good, getting her outside is even better (many hospitals have courtyards for this purpose). 

Other things: A high protein diet has been shown to help recovery; ask about diet and whether protein drinks can/should be used. Removing the catheter as soon as possible seems to be important, so ask about that - if someone is able to be with her much of the time, they may remove it sooner. Keep up the constant orientation even if she seems to be recovering well. 

Sometimes there's a choice between going to rehab or doing it from home, and honestly it can be hard to decide. Staying in rehab is easier in many ways and you probably get more sessions, but some people are more likely to get depressed and delirium remains a concern. Most people are happier at home but it complicates rehab, so you have to have both a motivated patient and someone who is able to help them. 

General recovery: https://www.mdedge.com/familymedicine/article/77278/geriatrics/hip-fracture-older-patients-tips-and-tools-speed-recovery

Delirium: https://acphospitalist.org/archives/2009/01/confused.htm

Best of luck to her. Don't forget to burn that rug 😒

[Guest]

My MIL, who is 93, fell last autumn and broke her clavicle. Not the same injury but I can still give some input about how things went. 

When she was in the hospital, she was a mess. ITA with Ottakee; she had a UTI that was probably why she fell in the first place. She acted like she had completely lost her mind. It was totally alarming to me for a bit there. She could not remember from what day to the next why she was there, what was the purpose of everything, even whether it was day or night. She was profoundly confused. I thought this was the end. 

While in hospital, her kids had someone there 24 hours/day. (I posted about it here.) I grant you, this is a luxury afforded by having a big family and lots of people who could take a shift. But I was glad for it most of the time because some of the hospital staff was CRAPPY. Some were amazing; a couple were amazingly terrible. One nurse was giving her a bedpan to use and was rolling her towards the injured arm, which was in a sling, so CLEARLY injured. I told her I thought she should be rolled in the other direction and she said, “Well, I’ve already got her rolled this way, so...” Umm...no. 

Care was better once she was transferred to rehab/nursing home. The family continued her 24/7 shifts. (I wasn’t able to be very involved by that point because of my cancer dx.) But what I saw of her was greatly improved at the rehab facility. She was back to thinking coherantly and they got rid of her UTI. 

The family made a decision to move her FT with the one kid who has few other obligations, as she is retired and does not have kids. They pay her like a nurse and she assumes all care for MIL. It does seem to me that her emotional health is the best in this situation and my SIL is truly outstanding in care-giving. My only sorrow in this arrangement is that this is the one sibling who lives hundreds of miles to the south, so it is difficult to see MIL at all now. We went in February and again over July 4th, but now it is unlikely we can go down again soon, and my kids definitely cannot. It takes 8 hours one way to drive. 

I think if the family had not rallied like they did and watched her constantly and made the decisions they made, she may very well have met with the end. I just don’t think instiutional care can ever be as healing as personal/home care, though I know many people simply cannot do that logistically. 

My SIL sent a picture of my MIL out to us all just this morning. She looks absolutely wonderful! 

[Spy Car]

Sorry to hear it Faith.

Tough old birds who push to rehab--and have support in those efforts--can make big comebacks. It takes work. But is do-able.

For others, unfortunately, a broken hip is often the state of a rapid downhill slide.

Stay away from opioids.

I would ditto the advice to rule out UTI with a urine culture.

Best,

Bill

 

 

[gardenmom5]

my grandmother broke her hip.  a big risk is being bedridden, not breathing deeply enough leading to pneumonia.

my mom had shoes she would trip when wearing.  dd threw them away where she couldn't get them back, and bought her new ones that didn't have the hazard.  

best wishes for your mil's recovery.

[PrincessMommy]

I'm so sorry.  You've already gotten such good advice I don't really have anything to add, but I wanted to reassure you that confusion is very normal (not wanted, but also not unusual) for elderly after trauma.  They just don't bounce back the same as when they were 20yrs younger.  Usually they will go backwards cognitively for a while (this is true with any type of stress as we age).  Keeping her calm and the routine as normal as possible is very good advice.  Also, agreeing that a UTI is definitely a possible culprit.  My mom used to hallucinate when she had a UTI.   Definitely look for reasons why other than the injury.  

 

[Kareni]

I'm sorry to hear about your mother-in-law, Faith-manor, and wish her well.

My mother fell and broke her hip when she was in her early eighties. She already had dementia at the time and had limited vision. She was initially in the hospital for a few days then in a rehab unit at the hospital for about a week (where she had physical therapy and they tried to teach her to use a walker) and then in a different rehab facility. Her first night at the third place, she startled a night nurse when she showed up at his desk sans walker. She had simply walked there from her room. She ultimately returned to the assisted living place where she had already been living. She died about eighteen months later after a different fall.

My mother, because of her dementia, would have been unable to advocate for herself in the hospital or elsewhere.

Regards,

Kareni

[Faith-manor]

Wow, Dr. Hive. You guys have been awesome with so much timely advice. 

I just got an update, and am heading back to the hospital. My theater group had a performance this morning, and another this afternoon, so i was out of the loop for a long time.

I did manage to briefly log in and look at 1 p.m., and then called dh. Thank you to the person who mentioned hearing aids. Dh didn't realize hers were turned off. Once he turned them on, she immediately perked up. 

The BP is still too high. She's had a lot of meds, so I'm very worried. Pain levels are okay. She isn't requesting much for meds which is very good given the opioid issues. Of course, she isn't moving around right now. I'm sure that if they stabilize her and she goes to rehab, she might have to move in ways that will cause a lot more pain. So we'll have to discuss that. 

I am taking her kindle to her so she can read, and play candy crush.

Ottakee, I will ask them if they've tested for any infections, and mention bladder infection. She already has kidney issues so my guess is they are monitoring that closely, but she is a bit prone to bladder infections.

Thank you all so much!

[Spy Car]

27 minutes ago, Faith-manor said:

Wow, Dr. Hive. You guys have been awesome with so much timely advice. 

I just got an update, and am heading back to the hospital. My theater group had a performance this morning, and another this afternoon, so i was out of the loop for a long time.

I did manage to briefly log in and look at 1 p.m., and then called dh. Thank you to the person who mentioned hearing aids. Dh didn't realize hers were turned off. Once he turned them on, she immediately perked up. 

The BP is still too high. She's had a lot of meds, so I'm very worried. Pain levels are okay. She isn't requesting much for meds which is very good given the opioid issues. Of course, she isn't moving around right now. I'm sure that if they stabilize her and she goes to rehab, she might have to move in ways that will cause a lot more pain. So we'll have to discuss that. 

I am taking her kindle to her so she can read, and play candy crush.

Ottakee, I will ask them if they've tested for any infections, and mention bladder infection. She already has kidney issues so my guess is they are monitoring that closely, but she is a bit prone to bladder infections.

Thank you all so much!

In my experience, one needs to stay on top of UTIs. They are often implicated in falls and not something you want to assume is being monitored. Hopefully, it isn't an issue. I would insist on a urine culture.

Opioids are detrimental in numerous ways (including the addiction epidemic we are all to familiar with). You want a person to get up and walk as much as possible. But not to mask pain that signals an appropriate stoping point. It is a balancing act (no pun intended).

You have had a lot to endure these last years. Big hugs.

Bill

[BeachGal]

The fall could be the only symptom of a UTI, especially in an elderly woman. Confusion, too. Definitely insist on getting her urine tested. The other meds could be affecting the microbiome in her bladder.

Many elderly people lose a lot of nerve connections as their muscle decreases which can also result in falls because their sense of touch has changed. Weight lifting/ resistance exercises can help as well as eating a bit more protein, maybe 10 more grams, per day.

[Faith-manor]

Thank you everyone. Sorry its been a while since the last update.

It doesn't look good. Her kidney function is very, very poor, BP hard to control. She was pretty lucid after her hearing aids were turned on, so we've been able to have good conversations with her. Yesterday late afternoon she fell asleep, and only awakened for a few minutes a couple of times since then. I guess that is good. She doesn't appear to be in distress. I think for her, as she has expressed before, she's had a great life, but all of her friends are passing away, and just last week, her sister in law died. Dh's dad, his two brothers, and now their wives as well. She still has a sister, but auntie's health is in very, very poor shape. MIL got to spend two weeks with her sis this summer, and her comment when we picked her up at the airport, was "This may be the last time we had together." I think maybe mentally, she is somewhat ready to let go. The fight doesn't seem to be there.

I am trying to help DH process it all.

[Melissa in Australia]

huge hugs

[Ottakee]

Hugs.