My father fractured his femur. He came home this past Sunday and has not the least interest in doing his prescribed home therapy. Any advice?

He doesn't want to die.
I believe he has improved a bit since he has started outbound physical therapy. All of us, including his therapist, think he's suffering from depression. We are going to bring this up with his physician at his next appointment.

Is it possible he has simply given up and wants to die?

Talk to the doctor. Tell the doctor exactly what is happening. Perhaps he is depressed and an antidepressant will help him. At his age the fracture experience, the surgery and the hospital/rehab stay can have a very negative effect on his mental and cognitive health. It is not the same as being 20 or 40. Unless you have seen several elder people go through this process, it is hard to understand the stress the person has experiences. Take him to the PT (if he will go) and let the therapist work on him. In the end, it is his choice. On the other hand, you don't have to help him stay in bed. Do not give him meals in bed, and remove the TV from the room, don't keep him company in there, etc. It might help if you do not keep urging him to get up. Have some fun in the living room. Maybe you will lure him out. With one relative, I was able to get them to do home exercises by doing them along with them. I had another relative who would not exercise after a hip replacement. This decision effected their quality of life for the rest of their life. I was sad to see, but I did what I could to help them and then it was their responsibility. I just had a course of PT myself. I could see some of the other patients (not elders) slacking off when the therapist wasn't looking--their choice.

If he will not cooperate you cannot force physical therapy. Give him time, maybe he will change his mind. If he does not just make the best of it.

My late mother fractured her femur 2 months shy of turning 80. She had to retire from her full-time job. She was on Morphine. If he's tired and in pain, let him rest untl he can get his strength and life back on track.

Sorry to heat! I understand what you’re going through. My dad was 70 when he had heart bypass surgery and it seemed like forever before he finally wanted to get out of bed. He was well also, no health issues at all. I’m thinking it maybe does something to their ego?.. not sure exactly what, but give him some time and be patient with him. Encourage him but don’t push too hard; that seems to make them climb back into their shell and refuse to do anything. All he really needs is for you to be understanding and for you to help him look forward to getting better. Don’t get discouraged.

My mom “took to bed” when the doctor decided she should no longer drive and we took her car. Seemed like she needed time to grieve her loss. I gave her a few days then started going everyday, turning on the lights and TV and saying “time to get up, you can not lay in bed. You and I both know where this is going. You have a cat to feed and Meals and Wheels coming to deliver your lunch. Let’s get moving. Don’t waste my time”. When she would say, “I don’t want to!” I would respond with, “neither do I, let’s get a move on”. You have to say it with conviction and move along without hesitating.

To be healthy for 80 years, I’m sure it’s a rude awakening to him to realize he’s not immortal 😉. Like others said, unless he wasn’t making progress, he should get OT and PT now that he’s home. Set it up and let them do it. Also true about the dementia getting worse. My mother had some confusion but living in an independent facility until she fell and broke her hip. She has a definite will to live , use the walker etc but the dementia has gotten much much worse since she fell 3 months ago.

If your hospital offers home health nursing and care, they will send someone to do an evaluation, and provide more PT and help with personal hygiene, etc. Please know that for many elderly folks, a trauma like this can result in the onset or worsening of previously un-identified dementia and depression and possible small strokes which add to the already traumatizing event. You will need to be very patient but persistent. The home care folks were the ones who brought my husband out of his self-Imposed isolation and helped so much.

Without trying to seem unduly harsh, are there some patients who simply can't be helped? If, according to the cliche, you bring the horse to water but he can't be made to drink, should we accept that he'll eventually die of thirst? Of course the "problem" with refusing physical therapy is that the patient usually survives but now needs even more care to make up for the neglect.

When home therapy starts they will make him get up and walk etc... As far as doing exercises on his own is a different story. I’m sure he is depressed and the anesthesia does effect them. Once home therapy starts you should see a difference in him BC he will have no choice. Do not serve him anything, he will realize that he has to get up to eat. It’s tuff love but you have to stick to it. He will be much better off by doing this. I have gone through every type of surgery with my dad and in the beginning I did everything for him and that was a BIG MISTAKE! Let the therapist tell him that he has to get up and move arnd, they take this better from them vs family members. You can talk to the therapist alone and tell them the situation and they will take it from there. I’m speaking from complete experience BC I have been through everything w my dad. Good luck and things will get better letting the therapist deal w telling him that if he doesn’t exercise and can’t be safe in home he might have to go to an assisted living, just have close contact w your home therapist is my best advise!!!!

About his depression and constipation, they could be related to the anesthetic he received during surgery. The anesthetic slows everything down, including neurons which regulate the brain and the colon. sodium docusate (OTC), water, and sitting or standing upright helps for constipation. After my kidney stone removal surgery, I was mysteriously depressed for 10 weeks. Couldn’t think and didn’t want to do anything. The only thing I could attribute it to was the surgery. I called the doctor’s office to find out what drugs were used: fentanyl and Propofol. Anyway, it may take a while for the anesthetic to get out of his system. My sympathies for you, your mom, and your dad. Please don’t give up! I send hugs your way!

As a retired PT, I can tell you that getting out of bed is more important than doing a few exercises. Laying in bed leads to blood clots, pneumonia and bed sores. Stop serving meals to him in bed. Does he get up to the toilet or use a bed pan? Does he dress himself? Give him a reason to get back into life.

I suggest you invite a male friend or relative over for a visit. He will probably not want to act like a baby when one of his peers is around.

To me (having a dad in a similar situation) it could be that he's depressed... having gone from being active and having no health problems, it can be a shock. After my own dad finally started feeling better, he then began doing more. When you have an active, robust octogenarian who goes from full speed (working on his cars, taking care of a huge yard and house, being involved in local politics, driving, etc.) to no speed (feeling weak, bed-bound, no appetite) it's as much mentally debilitating as it is physically debilitating.

Give him some time and try not to bug him too much (we bug because we care lol)... once he starts feeling better he'll most likely rebound. And it will improve his mood, too. Here's hoping dad is soon back to normal.

It may feel insensitive, but you will have to tell him that if he doesn't follow Dr's orders...He will be placed in in-patient physical therapy. This usually helps.

Time for the anti depressants and trip to the shrink. Then again, keep in mind after the injury and 2 weeks of that treatment away from home, maybe he does need a day or 2 or 3 off to just SLEEP and rest and be back in his own bed and home. Anything past that and refusing to do therapy should be taken up with a doc.

I had a similar issue with DH, when the home therapists came he put on a show, but doing exercises on his own was a no go. If I pushed at him I got the angry outbursts. So...what I did was take the family dogs into his room, (lap sized) and had them do goofy funny exercises which made him laugh-oh he hollered at first but I was relentless, then I would get the bands-those rubber band things and play with them and the dogs and have the dog carry the instruction paper in his mouth to him (all the non rubber band ones they wanted him to do) and do some of the exercises myself and next thing I knew he had done them all and we were done for the day. It took comedy to get mine motivated. And he has some severe mental issues and depression on top of dementia.

My dad broke his femur at 96 and never would get strong enough to walk again as he refused to do what was needed with his walker so now he is an invalid in a wheelchair. And he’s not good at being an invalid. He’s living in LTC now.
you've not mentioned if either of you have leveled with your dad and asked him WHY he doesn’t want to be active again. Have you? If so what did he say?

you've already said he’s said his pain level is low, my guess is he is depressed at this sudden change in his life and is in essence given up caring. When they lose their mobility, it’s life changing and can be hard to accept. Especially more so for men who want to appear strong. Anesthesia may also play into part of his mood as it takes a long time to get it out of the system and can do things to the elderly brain especially.

Perhaps scheduling him to see his family doctor for a talk about how he's feeling mentally since all this happened may help open the door to an honest conversation. He can be assessed for depression. I would go and tell the "nurse" you want to talk briefly to the doctor before he goes in to see him so you can explain why you brought him there. Then be in the room with them.

Thank you all for your responses. All three of us went to PT today. Luckily and by chance my Dad got the same therapist I had a couple of years ago with a back issue I had. He did his full assessment and then asked him about his pain on a scale of 1-10. Mom and I about died because he said 1-1.5!! He has been going around the house like he was feeling a 20 in pain. The PT asked if he had been doing some exercises at home. He told the guy "a few." I side-eyed him and motioned he hasn't been doing anything. The therapist gave him a very detailed sheet of new exercises that he did today. He told my Dad he had to do them 2 times a day and that if he wasn't committed to doing them on his own all of this will be a waste of time 2x a week on both their part. His hurt leg has zero muscle and is basically just hanging on his body. We'll see what he ends up doing. Prayers and fingers crossed.

By the way, my parents have a shih tzu and my dad loves the dog to death. We actually got permission to take him to his rehab hospital room once. It was a real highlight for both of them. Dad missed Lucky and Lucky missed him terribly.

About the constipation...the docs took care of all of that in the hospital when they took him off of schedule 1 pain meds. He's good, per my Mom.

You all have been an absolute blessing with your tips and listening to my ranting. I appreciate it!

Oh I agree CM. Sorry I left that a bit confusing. Although my mom used “ Syrup of Black Draught” for crabbiness, jaundice ( real or imagined) pouting, lack of appetite. Everything else needed a nap.

This may not at all be what’s going on. Just wanted to mention that if your dad is dealing with constipation due to all he’s been through, he may be trying not to take the pain meds. They do cause constipation. Pick him up some miralax and put it in his coffee or juice or even water. Also being constipated can bring out the crabby dad and husband.
So, it’s like a Domino effect. He has to keep the bowels moving in order to take the pain meds in order to exercise in order to regain his mobility, strength and balance.
Also make sure he’s drinking plenty of water.
Many 80 yr old dads aren’t going to mention constipation to their daughters.
Exercise, fiber, water will help us all.

He needs someone who goes to the dr. with him and rats him out. After DH's heart attacks last summer, he refused to get out of bed. We had a follow up with his cardio doc who requested I be there-DH would NEVER have allowed me.

Oh boy--the stuff hit the fan. DH is describing himself as being this model patient and then the doc looks at me and asked if this was true and I said "He doesn't do a single thing you've told him to do. In fact, if he will not be compliant starting RIGHT NOW, I am asking you to place him in a rehab facility. I CANNOT care for him at home." Yeah, it got nasty.

BUT--he started getting up. He went on low dose of Zoloft, which made a HUGE difference and he did "better" but never would exercise, and never will.

I had to be "b*tchy tough" which just makes me sick inside.

I even went so far as to say we could get a new dog (our sweetie had died 3 years prior and we hadn't gotten new one as I am sick of caring for dogs) if he would do everything Dr. requested. He wouldn't, kind of picked and chose and so I refused to even entertain the thought of a dog.

Sadly, as much as we want to be sweet, loving and caring with a sick LO, MANY people get sick or hurt and they simply will not comply with the "healing plan".

I DID put my foot down about meals. I would make all 3 meals and leave them in the kitchen. He HAD to get out of bed to eat, and when he did, I'd strip the sheets every other day and take my sweet time washing & remaking the bed. At least then he had to be awake & up for a while.

I am so not looking forward to his aging. He's only 67 and acts 100 somedays. They are going to take him off the Zoloft in a hew months and I know he is going to tank again---I may have to intervene.

Sadly, just being really, really tough and not particularly "loving" with him worked better than the "loving" wife.

If your dad doesn't start working on this, his muscles will atrophy and this will be the beginning of more falls, more broken bones--it's up to him. As far as the pain meds, Tylenol #3 is pretty mild. I wouldn't worry about addiction--keep him out of pain and he'll probably be less adverse to getting up.

Good Luck--I know this is very, very hard.

First of all, YES animals have a way of healing the mind and heart. I have seen it happen .And I am not saying to go purchase a dog, There are THREAPY DOGS that people bring in to nursing homes, Hospitals , privet homes, ETC. They are specially trained to help those who are hurting. The elderly are human beings that should be treated like human beings and I know first hand that dealing with them can be very hard. Through my hundreds of conversations with people between the ages of 70-98 and who had a physical issue, the most concern they had was becoming useless and a burden on others. If they like animals, a therapy or even someone's pet can help even if it is only for 30 mins 3 times a week.

The breathing is especially important if he is going to stay in bed. He puts himself at risk for pneumonia.
Even if he only sits in his chair he will be better off than being in bed.
Or is he having trouble standing up and down? That will emerge tomorrow with the Pt evaluation.
I was going to suggest that he take his pain meds before the pain gets bad but it is strange he didn’t need it as much in rehab. as he does now.
Maybe pay attention to the length of time in bed. Write it down when he gets up for the day, how long he stays up etc. You can track it to see if he gets better day by day. If he’s stalled you’ll be able to tell the doctor how much time he is in bed.
Is he getting dressed each day?
Dont let him get away with being crabby to you and mom since he isn’t doing what he is supposed to and pronouncing himself great to the doctor. It should be just the opposite. Complain to the doctor who gets paid to make him better.
We are all willing in the beginning to be our loved ones caretaker. But it wears thin when they want to act ugly and don’t do what would make them better.
Fingers crossed that therapist will uncover the problem.

He maybe going through a type of depression. Does your Father like animals? Get a therapy dog. He will need to take it for a walk, Get him in a wheel chair and take him to places he is interested in if he can be moved. Bring friends and family in for game night (his friends) Make sure he is not in pain. Get the family album out and go through pictures. T.ell him everyday that you love him no mater what his reaction. Read to him, Go get a joke book and tell him jokes till he cracks a smile. and don't just talk at him, ask him what he wants and ask him to help you understand it. Hope this helps

Thank you both for your responses.

Yes, he does get up to eat at the table at mealtimes. At night, he'll wake up my Mom for help to the bathroom. When he is up one of us always watches him when he walks with his walker. He's been prescribed Tylenol #3 for pain. When he says he's hurting...which he says is constantly since Sunday night...we give him his pills. An hour or so later, he says he's still hurting. While at the rehab hospital, he didn't take much pain medicine toward the end of his visit. Mom and I just cannot understand what's going on. Mom is fully aware and ready to be his caregiver. They've been married for 49 years and have always had a great relationship and mutual understanding.

He went for a follow-up visit with his surgeon yesterday. Hi x-rays were perfect. He told the doctor he was feeling great. He liked the way he was walking on his walker. He told my Dad to keep walking and doing his at home exercises. Dad agreed to his face yet shuts down once he's home.

On a side note, he was given on of those breathing things you blow into for your lungs. While at rehab, he was having oxygen issues being low. All of the doctors there told him to use it 10 times every hour. He never did. We told on him while he was there in his presence. He was certainly not happy with us once the physicians leaved the room. Toward the end of his visit he began to behave. O2 is fine now. They told him to use it at home 3 times a day. He picks it up once and inhales with it 70 times at once and considers that's enough! We continue to ask him to use it and gets irritated with us. One of his therapists at the rehab hospital is out now on surgery and the other is on vacation. He didn't have a relationship other therapists at the facility.

Outpatient physical therapy starts tomorrow and I don't think it will be pretty. Iv'e been through that same facility in the past; and it wasn't easy for me.

Mom and I are at our wits end. We cannot make or suggest he do anything for his well being other than eat!

Perhaps he needs a Tylenol (if he can take that) 30-minutes before doing home therapy. If he's in pain, he's not going to want to do therapy.

To go from having no health issues to breaking a femur at 80 must be a shocking blow to him. Nonetheless, neither you nor your mother will be doing him any favors by enabling him to stay in bed.

Do not serve him food in bed. Do not give him a bed bath. Do not offer him a bedpan or urinal. You must treat him as a grown man otherwise he will slide into dependency faster than he broke that femur.

Now also is a good time to look into getting some in-home help for your mother. A weekly housekeeper and someone to help her grocery shop, prepare meals, do laundry, etc. Can they afford that?

Is he getting up and going to the bathroom?
Is he eating? Being served in bed? Taking his meds?
Running a temp? Is he afraid it will happen again if he moves too much?

Perhaps there is something wrong. Good idea to check with his medical team.

Is your mom ready to be a full time caretaker to a patient who won’t do his part?
Its one thing if he can’t, another if he won’t.

I would make sure he is otherwise okay and then have a serious talk with him.
If he is depressed it’s time to treat it.
You and mom need to not enable him into becoming an invalid.

When I was about 30 I had knee surgery. A few weeks later on a follow up visit my dr saw how I was walking. I’ve never forgotten what he said. “You can bend that knee or I will.”
To therapy I went and I was dancing in high heels soon after.

Therapy works but it is work.

He’s lucky to have you.

I would try to give the therapist coming out tomorrow a heads up before they get there.

I should call his surgeon for advice, and possibly the PT team he was working with at rehab. The thing is, one would be tempted to leave it to the outpatient team - tomorrow, is that? - but after a break like that, in that long bone, and surgery, your father really can't afford to step down his efforts: it's not only about maximum recovery, immobility could be verging on dangerous for him.

It's in his interests that you're nagging him; the professionals might be able to suggest *how* best to nag him; and after that - it is up to him. If pushing him is getting nobody anywhere, you and your mother can still only do your best.

Is his pain relief okay now that he's home again, by the way?