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Seeking perspectives from nurses and family members/caregivers with relevant experience as we try desperately to inform ourselves and make the best decision for her well-being and quality of life going forward.


Some background:


My mom has multiple health conditions including high blood pressure, a-fib, (controlled with medication), COPD (without exacerbation, treated with oxygen and nebulized albuterol), rheumatoid arthritis, osteopenia, and vascular dementia that began after a stroke 7 years ago and has impacted her ability to speak and communicate her wants, needs, and experiences, such as pain.


She still had some mobility with a walker during the 5 years I took care of her, but within weeks of moving to the nursing home when we lost our place to live she began to lose her abilities as the staff slowly curtailed her activity until they had her (safely, I'm sure they felt) diapered, in a wheelchair, and unable to make herself understood. (In addition to some speech issues -- a holdover from the stroke -- the facility lost both her upper denture and lower partial).


Therefore because she was already wheelchair-bound, and because she is frail and has these health issues, the orthopedist assigned to her case feels that "this is a fracture pattern that can be treated nonoperatively." She would be bed to chair and non-weightbearing on the right lower extremity. If she did have significant pain and was unable to mobilize it and this poses significant risk then surgical stabilization with percutaneous pinning could be performed. The risks of surgery include but are not limited to bleeding, infection, neurovascular injury, wound healing problems, nonunion, loss of reduction, implant failure or migration and need for additional procedures. For the time being, we felt that a period of new management was reasonable to see how she does in terms of pain, as well as her medical conditions. A family meeting (my brother, who is power of attorney, will be attending by phone, and I will be attending in person, a meeting with the hospital's Palliative Care unit).


To be continued after my phone charges...

There are nurses on this forum who maybe able to help. Me, I would go with the doctor's recommendation. "Going under" for Mom may not be good with her COPD.

Maybe talk to an anaesthetist and ask how the anaesthesia would effect her. When it comes to pain, her BP going up would show she is in pain. My nephew feels no pain and this is how they knew he was experiencing it.
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Reply to JoAnn29
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Agavegrrl, you obviously have good insights into the possibilities, and you've gotten good advice from the responses. 

I can only add a few comments, focusing on attitude and support, the first sometimes being a function of the second.

If the family gets together, supports her in person, attends meetings and rehab, and lets her know that they're "there for her", it can make a big difference, even given change since the stroke.      

My father had 2 surgeries post falls, at ages 93 and 94.   The second was more problematic b/c the attending cardiac surgeon (who wasn't his own doctor) was reluctant to concur with surgery, but recognized that Dad couldn't live the rest of his life with a broken hip.   So we went forward with surgery.   And they were both successful.

What helped my father as well was knowing that he had support.   I kept family and friends up to date, cards came and I brought them to him.   A cousin created a card board which held probably 30 or 40 cards, and visitors sometimes exceeded the maximum number for a room.   The staff didn't intervene, probably b/c there was so much activity in the room that it was stimulating and supportive and good healing therapy.

I say have your family discussion, emphasize that in person support (in addition to yourself) is vital, ask church and neighborhood friends to visit,plan for a flood of cards to be sent/delivered,  and even if your mother does have some cognitive issues, all of that support should play a positive role so that she can approach this stage of her life in a positive frame of mind.
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Reply to GardenArtist
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Remember that pins are foreign objects and skin that is pierced with pins is a huge risk for infection. The risks of the surgery include death but also even worse pain than she has now. For now, the fracture is stable but another fall will completely change that.

In my opinion, it's not if she falls again but when. She doesn't need to fall for that fracture to destabilize; it can happen during transfer to chair even from using a Hoyer lift.

If I were in your shoes, I would get palliative on board now and sign the DNR papers to ensure that, should she arrest, she is not resuscitated, which is a horribly violent act on a body that old.

My MIL, now deceased, had more pain after her knee surgery than before. Us "kids" urged her to not have the surgery but she went ahead and did it anyway. She regretted having the surgery. She had hoped for a better quality of life after the surgery but it was worse.
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Reply to NYDaughterInLaw
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GardenArtist Jan 13, 2020
NYDIL, I'm sorry to learn that your MIL's experience was so challenging.  That's so unfortunate.
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These cases can have so many variables but this is my dads story.

He was living in memory care, age 89, decent health but no short term memory. Fell and fractured his hip, non displaced fracture.

Im the last living family member and oversee all aspects of his care. After talking tomstaff at the memory care, attending ER doc and ortho doc , I decided to let them proceed with corrective surgery. It was a simple procedure, small incision and three screws, took 15 minutes.

I was worried about the effects of anesthesia deepening his dementia but it didn’t seem to have much effect. Dad was a good candidate for surgery and rehab as he’s still a pretty cooperative get along type old guy.

Not having surgery would have left him bed bound and immobile and another fall could have done extensive damage to the already broken hip.
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Reply to Windyridge
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These cases can have so many variables but this is my dads story.

He was living in memory care, age 89, decent health but no short term memory. Fell and fractured his hip, non displaced fracture.

Im the last living family member and oversee all aspects of his care. After talking tomstaff at the memory care, attending ER doc and ortho doc , I decided to let them proceed with corrective surgery. It was a simple procedure, small incision and three screws, took 15 minutes.

I was worried about the effects of anesthesia deepening his dementia but it didn’t seem to have much effect. Dad was a good candidate for surgery and rehab as he’s still a pretty cooperative get along type old guy.

Not having surgery would have left him bed bound and immobile and another fall could have done extensive damage to the already broken hip.
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Reply to Windyridge
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Tough decision for the family.
Without surgery she may be in pain every time they try to move her. And that is a lot of moving. Every change, repositioning her, showers even a bed bath, a move from bed to wheelchair and back. And yes there is medication for the pan but that is a lot of medication.
On the flip side there are risks with surgery.
And if surgery is done will she do rehab? If not she may still experience pain although not as much as if she did not have the surgery.

I have heard that a Hospice patient that has a hip break will most likely dies within 6 to 8 weeks. I do not know if this is because surgery is not done or if it is because there are so many other underlying conditions.

All I can say is:
Make the best informed decision.
No matter what you do it will be the right decision.
Do not second guess yourself later. There are always "what if's" in life and you can't live like that.
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Reply to Grandma1954
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My mom was in almost the exact situation as your mom, absent the afib and copd.

I was sure mom would die during the surgery but they used a spinal anesthetic and she did fine!
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Reply to BarbBrooklyn
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My MIL who was a frail 92 year old with moderate dementia fell and sustained a hip fracture. I was shocked that the ortho at the hospital wanted to do surgery but as he explained, the facility would really be unable to mobilize her with this fracture without a lot of pain. It would be difficult to turn and reposition her or get her into wheelchair easily and pain would be terrible. We agreed and let him operate. She actually did very well. Fracture healed and she started using a walker which she had refused to do before. The surgery was done the day of the fracture. I am glad we did it because the next couple of months for her had less pain than if we had not done it. But we did have her evaluated by hospice after the fall.
I would suggest you have your mother evaluated for hospice immediately. They can help with pain management and she may benefit from extra attention as well.
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Reply to dogparkmomma
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