Surgery or hospice? She was mobile and enjoyed life. We had her scheduled to go to memory care next week, since the wondering at night was becoming dangerous. But, she fell while we were out for a walk (with her walker). ER doc is suggesting surgery. Opinions?

Thank you all for your advice and ideas! Glad I found this group! We did go with surgery, and she came through fine. The deciding factor for us was without surgery she would be bed ridden and in pain (of course hospice would take care of that), but she is very good shape and healthy except for the dementia. She got up every morning, dressed herself, made her bed, and cleaned her room.
again, thanks and I'll keep you posted!
Helpful Answer (25)
Reply to Jomo11
AlvaDeer Mar 22, 2024
Wonderful, Jo. Thank you for this update. How wonderful that the surgery went well.
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What is there to lose here?
She cannot live with a broken hip.
She was active.

She well may not survive the surgery, but she CERTAINLY will not survive the lack of it.
I don't see the choice. We don't at this point allow people to live with broken limbs that can be mended. Were this a cancer, a kidney failure, a heart failure I would call in hospice, as these organs cannot be fixed. A broken limb can.

I do want you to understand that the surgery itself may lead to hospice if she survives. Some cannot tolerate anesthesia at this age. Blood clots and poor healing and failure of major organ systems are a risk.

Get the recommendations of several doctors; her own doctor and a surgeon. Fully discuss.
Also ask her for her own wishes. I can imagine she is in quite a lot of pain now. But hopefully she will give you some idea. Be honest with her that a failure to not have surgery does mean death almost certainly, and no little pain (which can be addressed).
Your and her decision not an easy one, and I am so sorry.
I am 81. There's LOTS I won't do now, node testing, chemo, radiation, dialysis, tube feedings, etc. But I WILL do other things, such as surgical removal of a tumor, repair of a broken bone, and so on.
At this age am down to the "What-I-will-do-and-what-I-won't" stage of life.
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Reply to AlvaDeer
ElizabethAR37 Mar 21, 2024
Definitely, and my what-I-won't list is considerably longer! If her pain can be controlled, I would likely "just say no" to surgery. She may not be able to do ANY of the post-surgery rehab.
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I know that the OP's dilemma is resolved and that the mum has coped well with surgery, but I wanted to say to anyone else - do whatever is necessary to relieve pain.
If a surgery will lessen everyday pain then it should be undertaken, even if the procedure could lead to an acceleration of dementia. Chronic and extreme pain also leads to confusion and contributes to a deterioration of cognitive abilities, anyway, so the risk may as well be taken.
Quality of life is more important than quantity, and pain robs you of that.
Helpful Answer (10)
Reply to MiaMoor
Isthisrealyreal Mar 27, 2024
If they can do surgery without general anesthesia --they can use a spinal and sedation, I'd do it to keep her out of pain.
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Reply to BarbBrooklyn

You could do both.
That is what eventually happened with my Husband. I stopped in at the Hospice building and asked about Hospice and how I would know when he would qualify.
BUT he had already had the surgery AND...this is the biggie...he went through rehab AND participated.
If your mom can not participate in rehab there does not seem to make sense to put her through the surgery.
On average though a Hospice patient with a broken hip that is not repaired will die within the 6 month time frame.

Some things to think about.
Surgery is tough at any age but at 99 it is going to be very difficult that I think is the biggest thing to think about.

She WILL decline due to the anesthesia.
MC probably will not accept her if she is not mobile.
She WILL decline more when she is moved to Rehab, Skilled Nursing or MC. ANY move will result in a decline. As will the hospital stay for the surgery.
If she CAN NOT or WILL NOT participate in rehab there is no sense to put her through the surgery.
What is her cognition now? Does she understand the options? Have you talked previously about Health Care choices? End of Life, and "life saving measures" i.e., DNR, Feeding Tube, Intubation? If you have discussed this in the past or she has made comments those are your guide posts in making decisions. (within reason)
I hope this is now as clear as mud...😂 all serious now when making decisions you always have to weigh the Benefit VS Burden and you have to make the best decision you can with the facts that you have. If you do that then decisions are coming from the Head and not the Heart. Those are the tough decisions.
Helpful Answer (7)
Reply to Grandma1954
Lostcauz Mar 30, 2024
This. My 86 year old grandfather went to the ER for an amputation. He was talking, walking, fell out his bed maybe 1-2 in the last year, no broken bones.

Surgery goes well but the hospital delirium started. At two weeks in the hospital his decline was quick. He couldn’t talk to do physical therapy. Week 3 in hospital he stopped eating and would barely be awake. We decided against a feeding tube. Quality not quantity. We moved him to hospice week 4 and he passed away a few days later.

the doctors said my grandfather was living in the perfect balance. He stayed at the same home, had a daily routine so he was still able to function prior to his stay. Hell we had some cooking scares but he was smoking cigarettes up until the hospital stay.

wishing your mom a speedy recovery. The change in environment can really speed up the decline. Make sure you go visit her every day while she is in the hospital. You are familiar. That will definitely help prevent any issues while she is recovering in the hospital.
My friend's mother had a hip replacement at age 97. She lived to 101. She didn't move around much and had dementia by the time she died, but all in all, things worked out well. I hope your mom recovers well.
Helpful Answer (6)
Reply to Fawnby

Broken hip hurts immensely! Please allow her to get surgery and rehab afterwards.
Helpful Answer (6)
Reply to Taarna

It is often a fall that will be the final straw for an elderly person and cause their demise.
Putting a 99 year old person through surgery that will only cause her dementia to worsen sounds rather cruel and inhumane to me.
If it were me, I would want my family to put me under hospice care where they would keep me pain free and let me live out my days around my loved ones.
But that's me. Has your mom ever discussed before her dementia what her final wishes were? If she had, that should help make your decision a little easier.
Know that even if you choose to have surgery for your mom that she will more than likely never walk again anyway, and will be completely bedridden, so I'm not sure any of that is worth putting a 99 year old women through.
I would instead just keep her pain free until she leaves this world for the next.

And on a side note, of course the doctor is suggesting surgery as all the majority of them think about is money any more, and not what is in the best interest of the patient.
Why don't you ask them if it was their mother what would they suggest and why?
Helpful Answer (5)
Reply to funkygrandma59
Anxietynacy Mar 21, 2024
I get so frustrated with doctors doing that, and not giving older people options.
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I wonder the same thing! My mom can no longer communicate. The ALF recently called me thinking she had a stroke and asked if I wanted an ambulance to go to ER. Once there, the doctor asked me what I wanted them to do. He said if they ran tests and found the cause I would have to agree on treatment (surgery or whatever). He said if she’s not a surgical candidate then they won’t run any tests, so what did I want them to do? I didn’t know what to say! I simply answered I didn’t want her to be in pain with a trembling voice and tears. I think he felt terrible and ordered bloodwork. It turned out to be a UTI and antibiotics were all that was needed. But it was the moment I realized that at this late stage of the game the options are very limited when a problem arises that under normal circumstances could be treated. I’m so sorry you’re facing that!
Helpful Answer (4)
Reply to Dntcrybcitsovr
AlvaDeer Mar 21, 2024
Tests can be run on hospice. If treatment is done the patient comes off hospice unless treatment is FOR COMFORT. A fracture hip and UTI would be included in treatment for comfort. Time to call in Social workers on this one.
Your mother cannot walk with a broken hip and lying in a bed for 6 weeks in pain will be devastating to her.

My mother broke her hip when she was 91 and her surgery went very well. She was able to stand within hours of surgery and is still with me at 97 years old.

The anesthesia cause some confusion for awhile but it would be heartless to leave her in pain.
Helpful Answer (4)
Reply to southiebella

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