Fractured hip with dementia

yorkie46

Registered User
Jan 28, 2014
413
0
Southampton
Does anyone have any experience of a loved one recovering in hospital after surgery for a fractured hip?
My mum is 94 with advanced dementia. She has been a wanderer in the care home and this happened a week ago. The hospital want her to have oramorph prior to physio though they don't seem to be able to get this right!
My question really is, is oramorph a suitable pain relief for someone with advanced dementia? Are there any side effects I should be aware of? I don't have confidence that she is receiving very good treatment.
Unfortunately I don't live close by and I am reliant on my sister who has been very good and visited every day. It's impossible for someone to be with her all the time but she is totally confused with the situation. We are hoping to get her back to the care home soon.
 

MaNaAk

Registered User
Jun 19, 2016
11,750
0
Essex
I don't have experience of Oramorph but I want to say that I hope your mum feels better soon. I would get your sister to ask about the medication but I would have thought that the hospital should be aware of the situation.

Dad had to stay in hospital overnight some years ago and the hospital were very good. They were also pretty good when he was in hospital after a fall before he went into the home. He tried to wander up the corridor a couple of times and each time they followed him.

MaNaAk
 

yorkie46

Registered User
Jan 28, 2014
413
0
Southampton
Thanks MaNaAK.

Unfortunately I don't feel confident in the hospital about the care she's getting. My sister says when she first arrived in A&E they didn't know she had dementia. They don't seem to understand that she can't tell them if she is in pain, in fact she can't express her wishes or ask for what she needs. They keep giving her good she has difficulty eating despite being told that she really needs a pureed diet. She had some sort of slices of meat the other day, nothing like what my sister had ordered for her. I just fear she isn't getting the care she needs.
 

Shedrech

Registered User
Dec 15, 2012
12,649
0
UK
hi @yorkie46
could your sister find out if there is a dementia matron (or some similar title) in the hospital as they may be able to intervene for you
 

Banjomansmate

Registered User
Jan 13, 2019
5,395
0
Dorset
Both hospitals that The Banjoman has been in have had specialist dementia staff who came to the ward to assess him and advise on suitable medication.
When admitted through A & E his Care Home have made sure details of his dementia diagnosis went with him and before that I made sure the ambulance crew knew of his needs as I was unable to accompany him to the hospital.
On his last admission for a broken hip his confusion was greatly increased and cognition deteriorated so that he was / is now unable to interact with the physiotherapist to get him back onto his feet and walking again. He was violent with hospital staff, refusing meds and any form of help and at one point refusing food and drink. Once he returned to the Home and they found how stroppy he was they spoke with his GP and his painkilling patches were stopped and his behaviour improved.
As far as I am aware the hospital staff have tried their best to get him to eat and drink although sometimes food was just left for him until I pointed out that his visual field problems meant he couldn’t see it if it was out of his line of vision. Sadly the wards nowadays don’t have the “caring” aspect they used to have although the staff do their best and I have found them all pretty good. On his last stay they were getting him ice cream and hand feeding him to try to get nutrition into him.
Of course every situation is different.
 

Grannie G

Volunteer Moderator
Apr 3, 2006
81,445
0
Kent
My question really is, is oramorph a suitable pain relief for someone with advanced dementia?

I`m sure I have read of Oramorph on this forum so perhaps it is safe for people with dementia. I suppose it depends on how much pain your mum is in @yorkie46

Even if you have little faith in the hospital there must be someone you can ask.
 

Palerider

Registered User
Aug 9, 2015
4,160
0
56
North West
Does anyone have any experience of a loved one recovering in hospital after surgery for a fractured hip?
My mum is 94 with advanced dementia. She has been a wanderer in the care home and this happened a week ago. The hospital want her to have oramorph prior to physio though they don't seem to be able to get this right!
My question really is, is oramorph a suitable pain relief for someone with advanced dementia? Are there any side effects I should be aware of? I don't have confidence that she is receiving very good treatment.
Unfortunately I don't live close by and I am reliant on my sister who has been very good and visited every day. It's impossible for someone to be with her all the time but she is totally confused with the situation. We are hoping to get her back to the care home soon.


Its a difficult one on the oramorph front in anyone who is elderly let alone with dementia. Pain can exacerbate confusion plus your mum will need good pain relief in order to help her mobilise after the hip replacement. Its about getting the balance right, i.e. getting the pain relief to be effective for her to walk, but without make her drowsy and sleepy.

Not sure if you have spoken to anyone at the hospital (it seems you have some issues), but I would speak to the team looking after her and ask them abut her meds and raise any concerns you have so that they can answer them, that way everyone understands whats hapening and why, and if there are any problems they can hopefully be resolved
 

yorkie46

Registered User
Jan 28, 2014
413
0
Southampton
Thank you all for your helpful responses. My sister has today spoken to the ward matron and made it clear that there are several issues and a few shortcomings in mums care. He told her part of the problem is staff shortages but realised that wasn't an excuse for the attitude is staff and lack of appropriate care and recording. Turns out she has been refusing medication which isn't unusual but at the care home they talk to her and keep trying whereas in the hospital if she refuses that's it. Also they haven't been recording that she's refused and haven't been recording fluid intake. Nobody has been helping it encouraging her to.eat so that's very hit and miss. Regarding the oramorph he said they need to try to reduce her pain so that they can try to get her to walk but if seeing take it that doesn't seem to be working, it's a bit of a mess really. We feel she would be better back at the care home where the staff know how to deal with her and she might be more compliant. She is also back to being very grumpy and bored because she is getting no stimulation. My sister is going to try to speak to the physio again tomorrow. She is going to be on holiday next week but her daughters will visit mum and I will phone to keep in touch with what's happening. Hopefully things will all work out soon.
 

yorkie46

Registered User
Jan 28, 2014
413
0
Southampton
Some good news today. My sister visited and the matron was on the ward. Everyone was sweetness and light and very attentive. Physio reported that mum had been mobilising well and they are arranging a hospital bed, turntable and special commode for the care home. So it sounds like she might be home very soon thank goodness. This equipment was exactly what I had suggested for her in the first place but we were told on no she won't need that!
 

LizzieM

Registered User
May 6, 2019
54
0
Some good news today. My sister visited and the matron was on the ward. Everyone was sweetness and light and very attentive. Physio reported that mum had been mobilising well and they are arranging a hospital bed, turntable and special commode for the care home. So it sounds like she might be home very soon thank goodness. This equipment was exactly what I had suggested for her in the first place but we were told on no she won't need that!
Sounds like they’re taking notice which is good however so hate the battle it seems to be every time.
Oramorph - go for it, OH PWD ( before he had diagnosis of D but clearly something not right) had it whilst waiting for hip replacement. He was in excruciating pain and it took the edge off it. If you’re worried about Oramorph exacerbating Dementia then IMHumbleO constant unrelenting agonising pain will do that anyway.
 

Sirena

Registered User
Feb 27, 2018
2,324
0
Hopefully your mum will soon be back at the care home, where they are much better set up to look after her. My mother broke her hip last year and aside from the strictly surgical/medical issues the hospital were fairly hopeless at dealing with her. They expected her to eat and drink unprompted (which of course she didn't) and the physios couldn't get her to mobilise. Fortunately the CH manager was very proactive and got her home within 10 days. She didn't need any special equipment, she refused to use mobility aids (just used a carer's arm) and they used pressure mats to alert them if she got out of her chair. By the time she was back at the CH she was on codeine and then paracetamol. She was successfully rehabbed back to her original level of mobility.
 

MaNaAk

Registered User
Jun 19, 2016
11,750
0
Essex
Thanks MaNaAK.

Unfortunately I don't feel confident in the hospital about the care she's getting. My sister says when she first arrived in A&E they didn't know she had dementia. They don't seem to understand that she can't tell them if she is in pain, in fact she can't express her wishes or ask for what she needs. They keep giving her good she has difficulty eating despite being told that she really needs a pureed diet. She had some sort of slices of meat the other day, nothing like what my sister had ordered for her. I just fear she isn't getting the care she needs.

I think you could try informing Age UK and see if there is a way that you can complain or raise your concerns.

Thinking of you

MaNaAk
 

yorkie46

Registered User
Jan 28, 2014
413
0
Southampton
Thank you all. Mum due home to care home on Monday. She could have gone yesterday but the sensor mats hadn't been set up in time. They had to be done by the company who installed the alarm system. We decided with the care home staff that we would all prefer to wait the extra few days to make sure she is kept as safe as possible.
 

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