Should an elderly person with severe malnutrition anemia get physical therapy for reconditioning his new hip without addressing the anemia?

It depends on how anemic he is.

My question was why his anemia wasn’t found before he had surgery. Everyone has pre-op labs done. He may have lost some blood during the surgery to have caused the anemia, or not. Why wasn’t this found before?

A lot of variables here. We have an emaciated patient with a reddened area on his sacrum from your last post who appeared to have been on bed rest for months prior to surgery. Am I correct?

Where was he before all this happened? People don’t get malnutrition or anemia overnight. Malnutrition is a contributing factor to developing pressure ulcers.

Re his anemia. Often physicians don’t transfuse red blood cells unless the HGB is less than 7-8. Without knowing his numbers it’s hard to tell. Anemia can be caused by many things most common is low iron. Some people are prescribed B12 injections or take it by mouth for pernicious anemia. And of course bone cancer can cause anemia because red blood cells are made in the large bone marrow- femur and iliacs.

For bones to strengthen to produce red blood cells (all blood cells I should say) the bones need to be used and exercised. So your father has to get up and move. His inactivity most likely led to his reddened sacral area.

PT’s don’t order transfusions. The PT person could have just said this in passing without knowing his history. Some patients get CHF when transfused so they have to balance many factors. But if his HGB is not too low he won’t get transfused.

If you don’t like how he is being managed get him another doctor.

He needs to get moving, anemia or not. I suspect a lot of this is dad being tired is not only due to anemia but also because the man hasn’t had any physical activity in a long time. The longer he stays in bed the longer it will take to recover.

Push him to get up and do PT. Standing builds up the bone. Anemia or not, post op hip replacements need to exercise. His doctors can work to fix the anemia but right now dad needs to put some effort into therapy. Make sure they pre-Medicate him 1 hour before PT. I had a hip replacement @ 60 y/o- the pain he is having is post-op pain from the incision because the hip pain should be gone. I had surgery at 7:30am and they made me get up and walk at 6pm- around the nurses’ station! No more hip pain for me.

Given the number of issues you are having with your dad, I would ask for the Home Care RN to sit with you while you call Dad's doctor together and go over
1. Wound care treatment and plan
2. Anemia/nutrition treatment and plan
3. eligibility for PT
4. eligibility for hospice.

Make yourself a list of all the issues you'd like to get answers to. Are these comments about his being "an old guy" a veiled hint that he needs hospice? If so, they need to speak up and discuss it with you and with your dad, not pussyfoot around.

Yes. I don't understand why no food or water at all. This could have caused so many problems. Even being too weak for an operation.

If he was in pain, he may have refused food. If he was in hospital, he may have had IV fluid. But it does not have nutrients. There is more to this story that the medical staff withholding food. Elderly people often have failure to thrive. Even when they eat, they don’t absorb food properly. My FIL had anemia for years. He rarely ate red meat. He took iron which did not really help. He had chronic low grade kidney failure which also contributed to anemia
2 weeks ago, my FIL was found to have extremely low hemoglobin which did not improve much after 2 units of blood were given. He likely had some condition that was causing bleeding somewhere but at 95, with dementia, we elected not to put him thru any investigation of the source.
There are hazards to bed rest. PT is ordered to try to mobilize patient. It was ordered by the doctor. OP needs to have this discussion with his doctor. We don’t have enough information to provide advice.

What type of anemia does your Dad have? Pernicious anemia is caused by a lack of B12 and is not linked to iron intake.

Where was Dad prior to surgery that he was not given any nutrients?

Who has diagnosed the anemia?

There’s not really enough info here to give much help. First is what kind of anemia are we talking? Dies he need iron, or is it the kind that is the result of kidney damage? The kidneys make a hormone that they release to signal the bone marrow to make red blood cells. If there is kidney disease they can’t function correctly and do the person has a low RBC count. Treatment is not the same. Neither is the result of a few days without nourishment how old is your dad? Dies he have Dementia? Was he in the hospital a few days with a broken hip before surgery od was it both before and after surgery that he wasn’t eating. Has he been resisting nourishment before the broken hip or did it start with that. If it’s new onset delirium viiid be the cause and that is something that can be alleviated when you figure out what’s causing it and mitigate the need. As we age, however, our nutritional needs change, foods begin to lose their taste and our bodies do not absorb nutrients that we do eat. Protein. Calorie Malnutrition usually develops over a period of time that is much longer than you describe. PT can work with him regardless of treating anemia, but. Think more discussion is needed with the doctors about what is really going on and what can/cannot be done.

As an RN, PT does not address this issue. Anemia would generally NOT be a problem associated with a few days of no food. Given his age, it is more likely related to either a long-standing problem of malnutrition or problems with him absorbing B-12, usually called pernicious anemia. The first is addressed with getting him to eat a balanced diet. If he is doing that, then the 2nd issue comes into play - getting B-12 into his body. The most effective form of B-12 to be absorbed is through injections, usually weekly, for the rest of his life.

Since you are concerned about his nutrition, please talk to his doctor. His doctor can have labwork drawn to see if anemia is a problem, to diagnose the type of anemia, and to prescribe treatment.

As others have pointed out, your father's doctor needs to be treating the anemia, not the PTherapist. PT should begin as soon as prescribed. If you'd dad cannot stand, PT can begin with bed exercises. PT should not wait until anemia is resolved. I Is an important part of rcovery.

Why spent so many days without water or food?? Makes no sense.

I was a licensed PT for 40 years and I agree with Shane and dogparkmomma about the need for your dad to get out of bed. Lying in bed does not restore strength. There are several types of anemia and many causes, not all related to nutrition. I'm sure the doctor is aware of his condition.