Mom hip surgery and after effects.

Elvisman, re your 'Hardest news update'. 😢 Very sad for you.

Health problems can line up & have knock on effects.

I've heard a fractured hip called a 'game-changer' when past 90 (or close to). It's not just the broken bone, it's the total of anaesthesia, pain meds, delerium, being away from familiar home.

I've also heard medical opinions of likely/not likely to be here in 6 months. This is probably their best guess, based on their previous patients, plus your Mother's presenting illness & injury.

Mine had a huge stroke & nobody would have predicted she would be still here.
Only time will really tell.

Having hospice may be a good thing. It can change lanes - from the fast lane of rushing around all those Doctors & treating everything to the slow lane.. less meds, food she likes, comfort care.

I've asked many super aged folk now, what do you want? What would you like to do today? Often it is things like.. to sit here, to look out the window, some peace & quiet. One sweet lady just wanted to look at 'her tree' outside her window. She reminded me of a lovely baby, in a pram, gazing at the trees. It was enough.

I hope when the shock of that medical opinion settles, you can change down into the slow lane & find comfort in that.

I think having it home will be better and u may get an aide for bathing a couple of times a week. She will do better too. May take a while for the anesthesia to wear off. She may not go back to her normal. Breaking a hip is a shock to the system. Anesthesia is not good for anyone of a certain age. My Dad had a valve replacement at 65 and told his doctor he had lost memory. Dr told him the longer ur under the more memory will be lost.

My Mom went to Rehab after a UTI. I swore it was the last time she would ever go. She sat around in a wheelchair most of the day. I asked them to sit her on the couch because the WC was too umcomfortable for her with her bad back. I was told by the PT person that she could not remember her exercises from day to day or as she was doing them. I said maybe because she has Dementia. By that time she was probably stage 6. She would have done much better at her AL.

My dad had a hip replacement in his mid 80s with vascular dementia and did pretty well. His replacement was scheduled before the actual break and although his dementia was worse during his hospitalization he was able to do home PT and returned to his normal functioning level after being home; big improvement within a few days and a few weeks to completely reset. Hopefully your mom will follow a similar journey.
If you can afford help at home, I would not recommend pushing her into LTC at this time. Give her a chance to recover from the surgery before you look at moving her to long term care (if needed). Too many changes in a short time frame is harder for the elderly, especially if there is some dementia involved.

elvisman67, I see you wrote that she has been discharged to your home.

Having gone through a total knee replacement this past summer, I'm wondering if your LO is on any pain meds (opioids or OTC like Tylenol)? Because if so, they are incredibly constipating. Post-op for me the constipation was the most frustrating thing. It made me feel sick. I was taking prescription laxatives, stool softeners, fiber pills, drinking tons of water and it was still a problem for the entire time I was taking the pain med, even though it was just high doses of Tylenol.

If your LO complains of stomach pains (even high up, like under her rib cage) or hasn't had a BM in a while you may want to consider contacting her orthopedist or primary physicisan for advice, who may then suggest taking her to the ER. This is one of the most common problems post surgically.

Wow, Elvis, this is a fast discharge sending her home to you. And not necessarily a safe one.
How is her mentation at home?
How are you managing?
If this doesn't work out you need to call EMS and it's back to the hospital.
While she may not qualify for rehab, she may require some SNF placement.
Hoping she is adjusting well at home.
Let us know how it is going for you.

Yes! anesthesia is of the devil to dementia patients. My Mom had hip replacement about 2 years ago. She lives with me and my husband, I am her caregiver, so she didn't go to rehab. The worst part is that she could not remember NOT to make certain movements, had to tell her everything to do as it was encountered every day for about a month (even after that, her memory issues never recovered), and PT was a nightmare when the therapist came 2-3 times a week. Physically she recovered well, but the dementia definitely worsened.

Elvis, was there any discussion before discharge that perhaps mom's care was too much to handle at home, and that is was time to look into Long Term Care placement in a Nursing Home?

If you didn't have this discussion and if her care at home is not going well, call the hospital discharge folks to discuss placement. I believe you may have a short window of opportunity to do this

NH will not be paid for by Medicare. Does she have Medicaid, or does she have the resources/assets to pay for Long Term care?

Elvisman, just saw your update. Mom is home with you already?

Wow, you guys really bounce folk out of hospitals pretty fast eh?

Was it a total hip replacement?
You may find Mom doesn't remember the surgery & just gets up & moving with you! (Complaining of a sore leg or hip of course)

However, if it was a hip repair surgery, even though supported by metal screws, if the (broken) bone is still there I would expect it to still hurt.

But then again, pain is very individual.

What's the update on transferring out of bed?

Yes. This is everyday occurance for ortho wards with our aging population.

Hold steady.
Await the delerium to settle.
Once medically stable, onwards to rehab.

Was Mom at home before? Or residing in residential care? If so, going back to her familiar room & adding Physio visits may be something to consider & discuss.

Besides blood clots, avoiding falls & pressure injuries (bed sores) will now be priorities.

It is hard to do PT with delirium. If she is released in this state to rehab, she might not cooperate for PT sessions. My mom was 95 and PT was grueling initially with her dementia but thankfully got through it and lived for a few more years. If your mom fails a few sessions, then the rehab might release her before her alloted days are up. Keep your fingers crossed but consider looking for LTC

How does her orthopedist expect her to do PT when she has mod/severe dementia? It's hard enough when one doesn't have that challenge. From my personal experience with a very elderly Aunt with same level of dementia, she would not cooperate with anything and kept trying to get out of bed, even though her hip was never repaired. They were giving her PT to get her to pivot on it, but she died in her sleep in rehab, possibly from a clot.

Also, make sure she is getting enough fluids and food because some rehab facilities and hospitals don't spend a lot of time trying to encourage people to eat. They can't force them. They also can't force them to take the pain meds.

Where was she living: at home or in a facility? If she was at home, you may need to be open to her needing LTC now. Have very tempered expectations for her recovery and return to mobility.

My dad was 90 when he fell and broke his hip. He had it repaired vs. replaced and suffered terrible hospital delirium w/o dementia being a factor! It's absurd for the doctor to say, "she still needs to be in hospital until this clears(if it clears)" since the delirium normally does NOT clear while hospitalized but persists! In rehab as well. Moreover, an elder with dementia has a terrible time in rehab bc they have little to no motivation, little to no tolerance for discomfort, and virtually no ability to follow instructions from physical and occupational therapists. When they fail to make progress as a result, they're dismissed from rehab who then insists they move into their long term care section permanently.

That's how this scenario generally plays out. My father lasted 10 months after he broke his hip and failed to make progress in rehab......he had a brain tumor which prevented him from walking and being mobile again.

If you can get mom to walk, with a walker even, that's the best rehab for hip surgery to keep her mobile.

Best of luck.

My 90 yo mom, with a previous dx of stroke/vascular dementia broke her hip and had a repair, using a local anesthetic. She was in the hospital for about a week and then transferred to rehab in a NH.

She remained there as a LTC patient for
4 1/2 years.

Clot is a complication, and not a good one.
The blood thinners can cause bleeding strokes in the brain, and elsewhere, so worrisome.
Her age is worrisome.
Does she have a DNR status?
She will, I hope go to rehab as a try?

The anesthesia and dementia is terribly common and as a nurse I saw a huge amount of it. I cannot know how many improved at home.
I hope some members here have experience with elders getting increasing dementia in hospital and improving after being home. Hospitals can bring on temporary confusion with even a mentally very fit elder, so there is that.

The doctors will guide you and this is a step at a time day by day process now. Each patient is as individual as his or her own fingerprint. Due to poor balance in the brain's system falls are very common, and broken hip a very common result of a fall.
For my mother, her first fall was the beginning of the end in her early 90s. Some do well. But there are many complications to get past. I wish you the very very best here, and your Mom as well.