Alzheimer's progression after hip surgery. What to expect next?

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My Mom has AD and fractured her hip last week. She was moved to rehab on Friday and has done nothing but sleep since then. She will mumble occasionally to you, but will not open her eyes. The only way to get her to drink anything is to drip some water onto her tongue. Prior to her fracturing her hip, she had started undressing in the dining room of the personal care home where she lives. When the staff would try to stop her, she would hit or kick them. There have been so many changes in such a short period of time, I'm not sure what to expect next. She has had AD for about 4 years. Any ideas or suggestions? Is this the point that you ask for hospice?

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Thanks RobinsHere - I appreciate you taking the time to respond. Keeping them seated or getting them walking is tough and scary - I think my dad will be the same way, forgetting that he can't just stand up. I hope they find a solution for your mom.
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RobinsHere, depending on how she progresses physically, you might explore what the law in your state is regarding safety belts on the wheelchair, when in a long term care facility. I think personal care homes, are included. I have seen the option of having belts on the wheelchair that alarm when the belt is unbuckled. Could she unbuckle it? So, if she got up, it would alert the staff to go attend to her. There are alarms for the bed too, that alert if she gets out of the bed. She may need a doctor's prescription for them to use the one with the belt though. I would think the personal care home has used these before, if they are allowed in your state.
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Mom has improved as far as being awake. Her mental capacity is definitely not what it was before the broken hip. She talks quite a lot, but you can't understand anything she is saying. Unfortunately she is still not walking because she is too unsteady on her feet. She can't remember that she's not supposed to get up, so someone has to sit with her 24 hours a day to make sure she doesn't fall.

I'm not sure if it was the broken hip, the anesthesia or a combination of the two that caused the reduction in her mental process, but it has changed. She is still in rehab and unless she can figure out how to stay in the wheelchair, or get more stable at walking, I'm afraid she's going to have to stay there. I was really hoping she would be able to go back to the personal care facility she was living in.

Hopefully once they get your dad's meds straightened out, he will return to his new "normal".
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Hi RobinsHere, I was wondering if you have an update on your mom?

My story is very similar to yours! My dad (with dementia) fell on August 20th and broke his hip - fixed with a pin as it was the femur, not the hip ball. He had surgery the day after he fell and did pretty well with everything in the hospital. He went back to his NH 2 days after surgery and said a few things that worried me (he asked if my mom was coming home on Sunday, for example. She died 4 years ago and he hasn't mentioned her in over 2 years) so I alerted the nurse. When I went to see him a couple of days later he was alert and talking although he did ask me a couple of weird questions again. 9 days after his surgery he rolled out of bed onto the floor and was sent to the ER (he was fine). When I met him there he was very sleepy and kept asking if I had his house keys. When I went to see him yesterday, 14 days post surgery, he was completely out of it. It took a while to wake him up and he'd fall asleep almost right away again. I was cleaning his room and making a lot of noise and nothing was waking him. I woke him a few times, and he responded sluggishly, and then went right back to sleep. I asked the nurse if he'd had a med change and she went to check, but didn't come back before I had to leave so I'll call tomorrow and talk to someone who knows something. I know he was on Percocet at the hospital, but it seems weird that he hasn't been that sleepy the rest of the time he's been on it. I wondered if maybe they were sort of "restraint-sedating" him so he couldn't fall again.

I'd love to know how your mom is doing (and I'm sorry if I hijacked your thread, but it was almost as though I was writing about my dad!).

I did a lot of reading of studies written about the effects of anesthesia on cognition and it's definitely risky. Right now I'm where you were - I don't know if this is a meds issue or a "dementia kicked to the next level issue."
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She did have surgery to repair her hip. They were able to put in three screws rather than a hip replacement. Yesterday was the first time they were able to get her out of bed (her surgery was 8 days ago). She is still unable to feed herself or transfer herself in or out of the bed. When they had her in the wheelchair yesterday she had her eyes open but there was no recognition and nothing but mumbling. She is not on any pain meds. The only way she gets any fluid is by dripping fluid from a straw to her tongue because she won't drink out of a straw. I know she had lost about 15 pounds in the 4-6 weeks prior to her breaking her hip, but I have no idea how much she's lost since. I'll find that out today. I guess we'll give it a little while and hope that something improves. Thanks for your advice.
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There are many articles stressing the risks for Alzheimer's patients who have to undergo anesthesia. You can call Hospice for an evaluation. If there is zero improvement and she is losing weight, not intaking fluids or food, it is time.
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Did she have surgery to repair her hip? Was the hospital able to get her up and about after surgery? My mom, with Vascular demential from a stroke was being goten out of bed three days after surgery. ( she was NOT pleased).

I would ask the DON at the rehab what the plan is for starting therapy.

And yes, take care of you!
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That's a good point to inquire about her pain management. She may not be able to vocalize if she has any.

And ask her doctor and/or medical staff about whether hospice is appropriate at this time. Perhaps, they want to see how she's going to do. Did they give you a time frame for how long she might be in that condition? It's hard to say. I realize that.

We had a family friend with dementia who suffered a hip fracture and surgery and he was not able to recover from it. But, we have another family friend who did quite well. It seems that the dementia does lower the person's ability to recover though.

I know this must be so heartbreaking. Take care of yourself.
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Speak to the rehab staff. Ask about what pain relief she is being given, and what their assessment is. It must be frightening to see the state she's in, but I wouldn't write her off just yet. And although others will know better than I do, wouldn't rehab recommend hospice if they believed things had got to that stage?

My mother started undressing in strange places, too; although her dementia was principally vascular rather than AD. I think it was plain disorientation - she couldn't find her way around, it was as if mentally she was crossing her fingers and hoping she was in the right room. And I'd guess that your mother's aggression is to do with fear - people laying hands on her when she's in a state of partial undress, you can see why she'd want to fight them off.

Hugs to you. This is miserably upsetting. Hope you get some clarification very soon.
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