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Mother lived independently in her home in Mississippi until a fall and hip fracture in June 2018. Her cognition seemed appropriate, but she was sleeping and eating all day and had withdrawn from social activities. She said it was due to embarrassment about incontinence. Post hip replacement surgery, her cognition has been unstable and her ambulation is poor.


I relocated her to an assisted living facility in Georgia 1 week ago. Last Sunday, she accidentally took 3 days of medication from her weekly medication box and had to go to the hospital for evaluation. The doctor mistakenly transcribed that mom had a “past medical history of dementia”. Physical and occupational recommended that she go to subacute rehabilitation to improve balance and function. She was transferred to yet another facility and is more confused, calling me crying and insisting that I come immediately to see about her. I am an only child; I’m sad, confused, angry and unable to fulfill my job responsibilities. Does anyone have any suggestions?

Some rehab programs are pretty aggressive for a senior recovering from major surgery, requiring 2-4 sessions a day to quality for a rehab reimbursement. Sometimes these more general rehabs use programs unsuitable for seniors with hip replacements. For example one balance and function program asked seniors cross one leg in front of the other to walk sideways which is a major no-no for a hip replacement where you're NEVER suppose to cross the hip replacement leg across the body's mid-line. Seniors became less functional (due to pain from pulling on the new hip joint) and one ended up back in the hospital when the new joint was pulled away from the bone.

Post-surgical medications can have a dramatic impact on mental functioning even in younger able bodied individuals. It takes weeks to months for the impact of some general anesthesias to clear. In one case I read about a 52 year old college professor needed 7 months before she could lecture again - an extreme example but one to keep in mind.

Does the AL offer medication management? Is PT available there?

Consider placing Mom back into the AL with medication management and maybe hire an aid to be with her 8-12 hours a day for at least a couple of weeks. See if some daily PT could be scheduled at the AL.

If funds allow, consider a senior life case manager to help you manage Mom's care - at least for a while. The case manger could arrange the aid and PT, getting Mom's medical records corrected, take Mom to appointments and inform you of doctor's diagnosis and instructions. You have a single point of contact for managing Mom's care - letting you focus on work during business hours and visiting Mom before/after work.
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I saw this video on dementia and how elderly see the world within those brackets. It is a tough but necessary video that may share a lens different from our own so that we may better understand their perspective.

Created by nurses at Guy's and St Thomas' to raise awareness of dementia among staff, Barbara's Story is a series of 6 films which has changed attitudes to dementia in hospitals across the world.
https://www.youtube.com/watch?v=DtA2sMAjU_Y&ab_channel=Guy%27sandStThomas%27NHSFoundationTrust

Painkillers, depression and benzos can really increase frustration and crying jags that are heart wrenching. I cannot imagine how awful it must be to be in that state of mind.

Also note that many hospitals polypharmacy their elderly and there can be serotonin syndrome which goes unrecognized and is a horrible medical emergency. This happens with these combos of medications - esp if one is on opioids, benzos and antipsychotics.

They often do not get the care we think they are - I know this after hiring one of the worst agencies and though being here in their home, I still had problems with aides.

Make sure if you hire an aide they are fully vetted, experienced with elderly issues and compassionate. There is nothing worse for the elderly than to be in a state of confusion and have a bad aide.

God bless
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Hip replacement is a serious surgery, even more so in Seniors. If she was on painkillers, that makes it worse. Even though I bounced back from mine fairly quickly, I remember lying in bed after I took my oxycodone and watching the clock move across the room by itself. Surgery of any kind is a shock to an elder’s system. Taking more therapy is a great idea. I’d make sure she does it.

The messed up medication thing bugs me. It must have been bad if she had to go to the ER. I would contact that facility and have Mom’s records corrected. Doctors are human and they make mistakes, but that doesn’t mean we have to accept them.

I inderstand how Mom is anxious, emotional, and confused. She’s post-surgical, most likely in pain and among strangers, again. Her home is gone and she understands she’ll probably never go back.

Speak with the doctor at the facilty, or the nurses. Explain Mom is having anxiety issues and you just cannot be there for her 24/7. Ask if, for the time being, she could receive just a little extra attention. The aides were always so wonderful to my mom, I’d drop off pizza, salsa and chips, etc. for them every so often. Went a long way. And, if the medication issues keep happening, she made need a higher level of care. Or, ask if there’s a kind of medicine chest that may be electronic and could be programmed to dispense one day’s meds at a time. Check Amazon. They have everything!
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