I was asked this question during a recent support group meeting.

In recent months my mom had ER visits for 1) an infection..."probably pneumonia" that resulted in a 5 night hospital stay, 2) a broken shoulder due to a fall (she has difficulty remembering to use her walker), and 3) was found on the floor in her room recently with a lasceration at the back of her head which resulted in 3 staples and no other damage per scans.

She is now living in the best skilled nursing facility in the area and has the funds to support that. I am POA and only child. Moved mom to my city about 2 yrs ago.

Clearly there will be more falls/incidents ahead, and at the meeting I was asked what I would allow if she fell and broke her hip. Would I allow surgery and put her through physical therapy she will likely have problems doing, or will I set up hospice or palliative care?

Quality of life was the issue raised.

My goal has always been to keep her safe and comforable.

Twice during recent episodes she turned to me and said, "If I don't make it, I love you."

I lean very strongly toward comfort care rather than surgery in the event that she would break a hip or pelvis.

Your thoughts...or personal experiences?

Thank you.

At 90-something I would not want to be put through major surgery with many weeks of inpatient rehab. Your mother has dementia and inpatient anything is a risk factor for delirium. Prevention is best; however, if it were to happen, I would opt for palliative care.

That's my opinion because my late-MIL had her knee replaced against pretty much everyone's advice except for the surgeon. But of course the surgeon loves to cut so he was super convincing. She went through six weeks of twice-daily inpatient rehab, several more months of daily at-home rehab, had the best PT money could buy, and put every ounce of effort she had into it. But that knee was never okay. She remained in pain. She also suffered many neurological deficits because of that surgery. She regretted having had the surgery.

I think it's good that you are considering quality of life issues now before a crisis.
Helpful Answer (1)
Reply to NYDaughterInLaw

During the three nights I spent on an orthopaedic ward ten years ago - I was known as Cat Bite Woman, long story, I blame my mother - a lady was admitted who had just had her broken hip done. She looked about 530 years old and, as the nurse kept commenting, "she's as dry as a chip!" - in fact the nurse said that about every thirty minutes all night long until I could have throttled her, but the reason the nurse was there so often was that the lady didn't understand what the cannula was stuffed up her nostrils for and kept removing it. Though at least she didn't keep trying to get out of bed, unlike the lady I saw much more recently during a visit to the same hospital...

Anyway. Broken hip lady did fine, much better than the lady who'd been thrown by her horse or the other lady who was sobbing with pain but didn't like to bother the nurses; and the point is that dementia in itself is not a bar to successful surgery and recovery.

Broken pelvis you can't do anything about except wait for it to heal as far as I know. It's the weak joint at the symphysis pubis that tends to go, I believe.

But broken hip - wait and see. Depends on the break, depends on the surgeon, depends on what it's doing to your mother's wellbeing and morale as she is when it happens, depends on the anaesthesia available and her general state of health at the time...

I hope you're not actually being put under pressure to give a decided opinion?
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Reply to Countrymouse

Does your mother currently have "advanced dementia"? Does she know who you are? Can she make reasonable decisions about things like Hospice?

My mom developed Vascular Dementia after a stroke (she had previously been dxed with Mild Cognitive Decline and was living in a supportive, but independent living environment).

She fell and broke her hip; she was mostly aphasic from the stroke and clearly in a great deal of pain after the fracture. We asked the orthopaedic surgeon if he'd do this surgery on his own mom; he answer was a decided "yes". They were able to use spinal, not general anesthesia.

Mom was able to do rehab and learned to walk with a walker. She spent the next 4 years in a nursing home, declining slowly. She got to see another great grandchild born. She was generally content. She had a pacemaker inserted; in that case, we were able to ask her if she wanted it and she said "yes" after some thought.

I would not try to make this decision before you have to; the answer depends on a great many unknowns.

Investigate hospice and palliative care for sure and perhaps discuss those options with your mother now, while she able.
Helpful Answer (0)
Reply to BarbBrooklyn
jjmummert Dec 3, 2018
Thank you. Yes, many unknowns. She knows me, is doing ok with the walker now...when reminded...generally on an up swing now...enjoys conversations, watching people, listening to conversations, playing bingo (with assistance).....better off than many of her neighbors. Then has episodes of extreme confusion, can't express herself, does not recognize food items on her plate, difficult chosing menu items by herself, no longer reads, enjoys music, cannot stay engaged with a movie, likes to sleep a lot, would not understand or remember an explanation of hospice.
Contact Hospice.
I would opt for comfort care rather than surgery.

Is surgery a possibility? If so will she be able to participate in rehab? If not there may be no need for surgery. And surgery is very difficult for someone with Dementia. Actually it is the Anesthesia that is a problem as well as being placed in the hospital to begin with.
With all the other problems this is the down slide of a very slippery slope.
You know her best..what would she want if her brain was functioning properly? What would you want if this were you in the same situation.
Hold her hand, tell her you love her.
Helpful Answer (1)
Reply to Grandma1954

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