Broken hip

[charlie10]

Good evening everyone.....we've just had a text from BiL in England to say FiL has had a fall and is now in hospital with a broken hip. Any information about what might happen either medically (do they replace/let it heal by itself etc .....he's 90 and was a bit mobile with zimmer) and also the implications of his care now (no LPA, owns his house, savings over 23k,)

I'm thinking they might not do anything heroic with the hip, particularly if they suspect mental impairment, so he is extremely likely to end up in a wheelchair.....respite after hospital for rehab then either extra home care or CH? I'm also aware he might get delirium in hospital (just experienced that with younger person after a heart op here).....is that likely to push him further down the line, or does that 'wear off'

So many questions, sorry....my husband is so upset as he is so far away and BiL is obviously caught up in stuff at the hospital....it's the not knowing that's the worst! I'd be really grateful for any insight/experience you can pass on (I know it's out of our hands but if I can tell him possibilities he'll have time to let them sink in)

 

[Sirena]

Why do you think they would not do a hip replacement? My mother fell and broke her hip in June, she's 83, late mid-stage Alzheimers. (The other three ladies on the ward were all elderly, with dementia, and one had just had a hip replacement.) My mother had a hip replacement the following day, she was in hospital for ten days and went back to her care home for rehab. I am not aware a broken hip would 'heal by itself'. The doctors decided what was in her best interest and went ahead with surgery. She did not noticeably deteriorate as a result of her hospital stay - hospital induced delirium is a worst-case, it doesn't happen to everyone.

She was fairly quickly as mobile as she was before, although with a bit of pain which she has medication for. The hospital insisted on sending her home in a vehicle with hoisting equipment and a wheelchair, but as soon as they were gone by mother was off and walking with the help of a carer. It was important for her to get good rehab, which she got at her care home. This sounds a good point to get 24/7 care for your FIL.

 

[Amy in the US]

Charlie, I am so sorry to hear your news. It must be so difficult to be so far away and getting info in dribs and drabs.

Others will know more about the specifics with finances, but if he is self funding, then I would have the family on the ground start looking at facilities as soon as possible. We can point you towards some resources about that if it’s helpful.

I don’t know how it works with no LPA in place; can someone here advise on that point, please?

You are right to be aware of hospital induced delirium, especially with anesthesia and painkillers. If the family can hire or provide a 24/7 sitter, I would do so, especially after surgery, if he has surgery. Otherwise all you can do is hope he doesn’t get it. The only cure I know for delirium is to treat any underlying cause (medication issue, physical problems and so on) but if there aren’t any then all that you can do is to give it time and provide as calm and stable an environment as possible. I have been through this with my mother a couple of times and it’s hard. It is possible to return to baseline after delirium but I don’t know if there is any way to predict what will happen.

When my mother has had delirium/an acute confusional state, she has generally recovered from it either back to baseline or almost, but it is hard to judge because of all the other things going on.

This must be such a worry and I am so so sorry to hear about the fracture. I hope the silver lining is getting him somewhere safe with good care.

I’m so sorry. Best wishes to you and your family.

 

[SnowyOwl]

Good evening everyone.....we've just had a text from BiL in England to say FiL has had a fall and is now in hospital with a broken hip. Any information about what might happen either medically (do they replace/let it heal by itself etc .....he's 90 and was a bit mobile with zimmer) and also the implications of his care now (no LPA, owns his house, savings over 23k,)

I'm thinking they might not do anything heroic with the hip, particularly if they suspect mental impairment, so he is extremely likely to end up in a wheelchair.....respite after hospital for rehab then either extra home care or CH? I'm also aware he might get delirium in hospital (just experienced that with younger person after a heart op here).....is that likely to push him further down the line, or does that 'wear off'

So many questions, sorry....my husband is so upset as he is so far away and BiL is obviously caught up in stuff at the hospital....it's the not knowing that's the worst! I'd be really grateful for any insight/experience you can pass on (I know it's out of our hands but if I can tell him possibilities he'll have time to let them sink in)

 

[charlie10]

thank you for your reply Sirena....we've not heard any more from England, presumably BiL is still at the hospital and has other things on his mind. Your point about 24/7 care is a good one, and we have been thinking about it.....he has severe vascular disease and his mobility is not much more than a few steps with his zimmer so not sure if he's going to continue to be mobile after this. Trying to think thro the decisions we might have to make (or maybe SS as we don't have LPA).....complicated by him never having seen a dr about his possible dementia (and tbh we sometimes think we've got it wrong as he sounds more or less ok on the phone and Bil thinks we're catastrophising!) Without LPA and/or a diagnosis I'm not sure what anyone can do if he still insists on no care help, let alone a CH, as he was doing last week. Well, maybe the shoe has dropped and we need to just follow where it rolls to....

 

[Sirena]

I don’t know how it works with no LPA in place; can someone here advise on that point, please?

.

Unless FIL agrees he'd like to go into a care home, I think there would need to be a meeting with SS and family to determine best interests. (If he agrees, as he's self funding you can go ahead and find him a care home.) However whichever of those options applies I presume you would need either LPA or a Court of Protection deputy to control his finances so that care can be paid for.

 

[SnowyOwl]

My Mum 85 fell and broke her head of humerus and head of femur(hip) 2 years ago. They did a partial hip replacement under spinal bloke-Mum remembers nothing. Her shoulder had to mend itself. She was in hospital 13 weeks as physio was slow due to her not remembering but she came home and was able to move around with a zimmer and still walking round now, Its the alzheimers thats stopping her walking now, not the hip. If you dont have Power of Attorney then if need be it would have to be Guardianship. Local Authorities will put a charge against a property to be repaid once legalities sorted and property sold. If Attendance Allowance has not yet been claimed it should be

 

[SnowyOwl]

Unless FIL agrees he'd like to go into a care home, I think there would need to be a meeting with SS and family to determine best interests. (If he agrees, as he's self funding you can go ahead and find him a care home.) However whichever of those options applies I presume you would need either LPA or a Court of Protection deputy to control his finances so that care can be paid for.

 

[charlie10]

thank you Amy.....it's just good at the moment to be able to talk about it in the absence of any definite news. When we started to suspect all was not right with him after his Oct fall and hospital stay I looked on-line at homes local to BiL to try to short list them.....I thought it might have been a good idea if they could visit a few at their leisure, maybe even get him onto a w/L..... but with the total lack of belief in anything being that bad they were unwilling to invest the time or thought. If it was my dad and my brother was dragging his feet I would stamping mine very loudly, but it's different with in-laws

Any ideas about lack of LPA/diagnosis and how it might pan out would be gratefully received....my mind goes round in circles!

And is it possible for someone in a wheelchair to live on their own at home with visiting carers (worst case scenario )

 

[SnowyOwl]

Lasting Power of Attorney given by the person when of sound mind. When they lack capacity without LPA in place then Court of Protection and Guardianship is required. I think there is an annual charge for this. Also check out Continuing Heaalth Care CHC funding from NHS. If a person is in a care home and self funding they can receive payments of Attendance Allowance-Approx £85 pw. If there is an agreement to repay from the sale of a property the Local Authority may give 12 weeks at a discounted rate and Attendance Allowance not paid for that period. If there is a possibility of returning home, before buying new stairlift ask about reconditioned one. With a small alteration to the stairs we saved £3000

 

[Prudencecat]

My mum broker her hip after falling at home. She is 88 and had a partial hip replacement. They gave her a spinal block and sedation as they didn't think she would stay still otherwise, they were right! A few hours later she was sitting up and eating her tea. We asked her if she had been worried about the operation she said no but was wondering where the baby was. I can only think they have said epidural and she has made that connection.
She spent 2 weeks in hospital then went to rehab for 4 weeks the main problem being cellulitis which took 4 lots of antibiotics to get under control. She is mobile again with her zimmer. Unfortunately the delirium hasn't worn off and dementia has got worse. On the plus side she is a lot more pleasant than she was before going in to hospital. Although she doesn't make a lot of sense she still speaks fluently eats and drinks

 

[charlie10]

Hi @SnowyOwl ....thank you for your reply....it's encouraging to hear of other elderly people recovering fairly well. Your mum must be one tough lady to recover from a broken shoulder AND a hip....hope you have her genes! The added complication is that we have no official (or unofficial really....just guesswork from us) indication of lack of capacity. Hoping that the hospital might investigate that, but if he does get delirium that might muddy the waters somewhat.

Oh, and welcome to the forum too

 

[charlie10]

@Prudencecat .....glad to hear your mum coped so well with the op (will be worried if FiL asks about the baby tho ). Cellulitis is a worry for FiL as he has lymphedema and multiple arterial ulcers....hopefully the hospital might be the ambulance at the top of the cliff and put him on antibiotics as a precaution. Thank you for your reply

 

[love.dad.but..]

Oh dear it must be so difficult from so far away. One of the problems I saw of residents in dad's NH when he was there was that even with a hip replacement done often the pwd did not have the understanding to follow instructions do the necessary physio so often independent mobility can be lost. I can't imagine he would be allowed back home with a degree of mental impairment and lack of mobility without 24 hr care and self funding that would be very expensive and hoisting equipt 2 carers needed...visiting carers would be inadequate...say for instance he tried to mobilise on his own from a wheelchair...fell...and couldn't get help. OT would want to be sure before hospital discharge that he could manage basic functions on his own. Could your OH phone the hospital on Monday when drs are on duty after the weekend to find out a clearer picture and perhaps knowing the proposed treatment etc will help you to not have to think worst case scenario ?

 

[Chrissie B]

Hip replacement, free on NHS. Doesn't have to be put to sleep, and a fairly standard procedure. They will keep him in hospital until they are certain he will be fine back at home. Physio afterwards, also free on the NHS, but BiL or FiL will have to pay for travel there and back. He will have to go back to the hospital for checkups and for physio, BiL or FiL should ask if there is anywhere local that does the physio, if it's easier to get to that way, the hospital won't suggest it if they don't. The main problem will be ensuring that the exercises are done afterward, which will be the difference between going back to the same mobility as previously had, or struggling with walking.
My mum had her hip replacement in her mid 80's and a few months later once recovered she had a knee replacement on the other leg. Hip replacement was very easy but she did find it easier after having her knee replaced to walk with 2 walking sticks. She's really only started to deteriorate with her walking ability on a serious level last year after she got to 95 years old, and even now she still manages to walk with 2 sticks, but she is now getting to be unsteady and is very slow. When she was only 94 years old, she could still walk without too many problems for about an hour provided she had a 10-minute break on the halfway mark.

If at all possible urge to get LPA. They don't need a solicitor, a friend who knows them and doesn't live at the same address can be a witness. Would they feel better if you or husband had the LPA or was made joint LPA?

 

[Amy in the US]

LPA would certainly make things easier and it’s worth a discussion. It is possible (because this happened with my mother) that someone at the hospital can prompt this as “getting the paperwork in order” or similar. Just a thought.

Please advise the family on site not to agree to a discharge to home without all the proper assessments and carers and equipment in place ahead of time. I would think he would have to go to some sort of rehab or nursing or other facility, but am not sure how it works there. But if pressured, they must refuse the discharge and be firm about it. They can say they don’t want a failed discharge and he is a vulnerable adult at risk. Just hope there is a reasonably competent social worker.

My mother fell and fractured her kneecap in 2017, which required surgery, a stay in hospital, and a longer stay in a rehabilitation facility. I have some idea of what you’re facing and I’m sorry. We will all hope for a good recovery.

Please keep us updated. I’m so sorry!!

 

[charlie10]

wow @Chrissie B .....your mum is doing well thank goodness my dad (93) is also very active and has only just stopped walking up the hill to go to Waitrose.....now he drives there but incorporates a good hour walk round the Common in the same trip. FiL is not pro-active.....he had a home visit from physio after his Oct hospital stay....was told to do the exercises or will soon be bedbound, but he didn't so I'm not counting on him being compliant after this either.

Our update is that he's on a morphine pump in the ward now and will see the ortho surgeons on Monday....he may have a replacement or they may decide his heart and general weakness make him a bad candidate for surgery, in which case it would be a wheelchair. We're so far away we can only suggest/advise BiL........if he doesn't want to hear it there's not a lot we can do. All good for the moment tho.....FiL is in safe hands, so we have a bit of a breather before the next incident (I hope!)

 

[Chrissie B]

The good news is that the doctors are pretty good, and will know what to do for the best. I think your dad has the same determination as my mum.

 

[charlie10]

"They can say they don’t want a failed discharge and he is a vulnerable adult at risk."

thanks Amy......I'm going thro the forum and making a list of all the buzz words for my husband to pass on to his brother. I have learned more in the few weeks I've been looking at this forum about dementia than I ever wished to know.....but I'm truly blown away by the generosity of everyone who shares their knowledge and experience of this horrible disease. And I also think that all you carers are awesome (in the old meaning of the word, not the modern sense which is used so frequently and casually).....quite restores my faith in humanity

 

[Witzend]

Sorry to hear this.
Can only say that my mother at 91 or 2 fell and broke a hip - her dementia was then quite advanced. It was very quickly operated on and she made a very good recovery quite quickly. She was certainly more wobbly afterwards but since she would never remember to use her Zimmer frame, she still fell now and then, but luckily nothing serious. Once back at her care home she was given no physio - to be frank, given her stage of dementia (and frequent stroppiness!) she would never have cooperated. She needed no encouragement to walk, however - had always been a 'wanderer'.

She lived on to 97 though I will admit that although outwardly so frail-looking, she had the general constitution of a rhinoceros, so I know this sort of outcome may well be unusual.