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97 yo grandma now has a hip fracture complicated with CHF, afib, severe aortic stenosis on HOSPICE -- what to expect??


I just heard my grandmother broke her hip today. She's on hospice using morphine for chest pain and palpitations from time to time. She lives independently. Her hospice nurse says she doesn't think a surgeon will offer her a surgery since she's too old given her health.


What info can you share here and what can I expect? My grandmother doesn't want to be bedbound and wants to remain in her home. She's a very stubborn woman and I am her primary caregiver at a distance. I'd like to know pros and cons of outcomes if surgery is even offered. She will not enjoy rehab, not a good patient if things are not well.


Many thanks.

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Update. She has a left femoral neck fracture and left wrist fracture. She met a "cowboy" surgeon alright. He explained to me her life expectancy outcome would likely be better with partial hip replacement since it will not heal on her own, and she does not want to be bedridden. She is a "high risk" patient no doubt. No surgery planned for wrist, that will fuse and it will be immobilized, so that will complicate her recovery. They expect her to put weight on her leg within a day of surgery. The surgeon told me the first 24 hours after surgery are the most critical for her.
My grandmother makes her own decisions and doesnt ask too many questions. Im concerned this is going to be a very difficult road for her. Im not certain she has the strength, the overall health to endure a surgery, recovery, 30+ day rehab, and deal with her heart problems despite her massive will power and internal strength, stubbornness. Ive seen her breakdown, crash mentally, and become depressed, then rally back with CHF.

I'm usually very optimistic, but this is going to be tough.
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My 95 year old mother with moderately advanced dementia cracked her hip (hairline, barely displaced fracture) -- moderate aortic valve stenosis, afib, but no CHF. Surgeon required a cardiologist to evaluate her and give OK for surgery. They explained the risks to me ... they could do surgery, put in a couple of pins, and she'd be able to get on her feet the next day, but there was danger of her dying ... or she could become bed bound and go on hospice. I chose quality of life and opted for the surgery, after talking to her sister, who agreed. Was quick, went well, no trouble from the anesthesia, she walked about 800 feet 2 or 3 days later. Then did need 3-4 weeks in rehab, as the walking had been when she was in fight/flight reaction and she strained some things. But she did get back to where she'd been, which was walking with a walker.

Now, that was a simple hip break. How bad is your grandma's break? If the ball of the femur broke off, that's harder surgery. They have to make a big cut and replace the ball. Also, you'd have to find a surgeon who's a real cowboy, and an anesthesiologist who's the same. My mother's surgeon told me that he once fixed a hip on an old lady when the cardiologist gave her a 90% chance of dying (severe aortic stenosis). Cowboy.

So ... there may be no choice in the matter, in which case grandma will be bedbound and need 24/7 care, likely in a nursing home. If they give her a choice, it's a hard one, trying for quality of life but taking a big chance of dying in the OR, or surviving and having her brain messed up, or a stroke ... or opting for possibly longer life, but bedbound.

Blessings on both of you, if you have to make the choice.
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Gladimhere,
24/7 is going to be hard on her. She doesn’t want anyone living with her, but wants to stay in her home.
I’m afraid a surgery would be just too much on her. She’s on Coumadin too. Sh’s reluctant to take pain meds believing she’ll become addicted, so old school thinking. But takes morphine when her palpitations start up. She won’t listen to my suggestions but I can try to gently nudge her. She’s a tough old broad. I’m expected to help, yet it’s like trying to help her with one arm tied behind my back and a gag in my mouth. It’s a frustrating situation and I imagine things are going to become worse. She’s not a good patient. She will not be pleased bedridden. The pain meds will affect her moods, not sure how she will tolerate this along with the CHF.
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Yes, on Hospice. Her mind is sharp, with short term memory issues. She cooks and does very light chores. She’s on O2 as needed. She has a nurse on call as needed. Plenty of help to run errands. She showers daily when she feels well. She can do her own light laundry. She’s well except her heart.
She is 110# 5,2”. All bones and wrinkles. She gets winded easily.
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She's on hospice? I wouldn't even consider the surgery. She will probably need 24/7 care. What kind of help does she have now at home?
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Do not accept the surgery if it is offered. Hip is very hard on them. The anesthesia could be even harder. It could bring on dementia symptoms that may or may not be a permanent new issue. If her brain is working now, I suspect it is if she lives independently. After surgery she will not be independent and would need at a minimum rehab.

She now needs 24/7 care after the hip fracture. Whether it is caregivers at home or in assisted living.
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