deteriorating fast!!

[jaws]

Hi Everyone,
Dad has been in the nursing home since November. Unfortunately, he fell and broke his hip before Christmas and had a new hip before being dicharged back to the nursing home on Christmas Eve. He is now immoblile and we don't really know what the chances of him walking wil be. We have been told that physio is difficult and unlikely due to his cognitive dysfunction. We are considering employing a private physio - why should he be written off??!!! More to the point though - he has become increasingly confused and incoherant at times. He can tell you his name and address but nothing about his family. He is declining a lot of food and drink. We try to push this each day when we visit but he gets angry with us. He looks very very sad and depressed and it's breaking our hearts. Does anyone have any experience of mobility returning? He used to walk and wander all the time and I think his lack of mobility is causing him to give up.
Happy New Year Everyone.
XXXX

 

[Devonmaid]

Hello , so sorry to hear about your Dad . I dont really think I can tell you what might or might not happen as everyone is different and I am not qualified . It is a sad fact that often, memory and thought processes do become worse after trauma and especially after operations . My Mum already had Alzheimers when she had to go into hospital for a very minor op , nothing as serious as a hip replacement but even so, it signalled the decline for her . Sorry , I guess this isnt what you want or need to hear and everyone reacts differently but you should really speak to the Doctors and try to keep positive, hard I know and I wish you good luck , so sorry ,
Kate x

 

[Brucie]

why should he be written off

most likely not so much a case of this as a realisation of the realities.

However, that should not stop them trying!

When my Jan fell while in the care of the NHS, she fractured her pelvis, hairline fracture.

She never walked again. Before the fall she could walk unaided.

 

[jaws]

Hi there,
I guess we don't want to hear anything that isn't good, do we? I suppose I feel guilty that he was 'better' before going into the home but my rational side says he went to live in the home because he was deteriorating fast anyway and he could have fallen at home but not been found for hours. I don't want to become one of these guilt ridden complainers who finds fault in his care all the time but I want to look out for him too - it's a fine line between them!
XXX

 

[Grannie G]

Hello Jaws.
My husband fell and fractured his arm 2 years ago, still in the early stages. Physio was impossible. Even on the initial visit to outpatients, he hadn`t a clue what the therapist was trying to ask him to do. In the end, I slipped a note into her pocket, telling her he had Alzheimers.
So I`m sorry, but even if you go privately, I doubt it would help your father.
Love xx

 

[Nebiroth]

I have to agree with Grannie G. I think it's unlikely that your dad has ben "written off". It is more an acknowledgement that his cognitive decline makes physiotherapy impractical. For example, he might well not be able to comprehend instructions, or be able to remember or follow them. Also, physio therapy often brings with it a degree of discomfort. How do you explain to someone in you're dad's situation, let alone convince them to continue? What is the risk of his doing the wrong thing and injuring himself further?

Refusing food and drink is also not uncommon. You can't force someone to eat if they don't want to. Certainly, the care home can't go against his wishes because that would be abuse.

I understand how you feel, but there's no point in "pushing" your dad to eat/drink. It's an argument you can't win because reason, logic and rationality don't apply and it will only cause both you and dad a lot of distress.

Perhaps you could speak to whoever is in charge of nutrition at the home. The usual approach is "calories". You just try to get someone to eat enough that they don't actually starve, even if the diet is "unhealthy".

 

[jaws]

Thanks to you all for your support - I take it all on board. It really helps. I don't post a lot but I read every day. Once again - thanks. XXX

 

[germain]

Hello Jaws,

Hope this helps a tiny bit re the eating & drinking problem. Our Mum lost an appalling amount of weight when she was in hospital recently and came out refusing to eat and drink too !
We found that she hadn't actually been offered very much to eat at all and hadn't been helped to eat it either.


I know that this my seem strange but it was almost as if she forgot that she had to eat & drink at all and didn't seem to get any hunger pangs or thirst. She got very irritated with us when we tried to push food etc


Anyway - we have been going thro' the refusals etc and just to encourage you a bit - after a month we seem to be coming out the other side. She's now started to eat properly again - not a lot but still very encouraging.


We used liquid Ensure and anything at all that she liked, including yoghurts, chocolate,cocoa with sugar and cream, smoothies,mini liqueur coffees with double cream and loads of sugar, ice cream etc. All probably very "unhealthy" at the time but we didn't care. I must have been the only person in the land searching the supermarkets for the HIGHEST fat Yoghurts and Highest calorie ice cream ! Ice cream sodas are very tempting also !


Our Mums memory consultant also mentioned that she may be refusing food and trying to sleep 24/7 because of pain (she had severe bed sores and arthritis) Since she has been prescribed light painkillers we've seen an improvement even tho' she never actually said she was in pain.

Hope this helps - don't give up - your Dad may return to his normal pattern after a while - or he may develop a new pattern for himself - as someone has already said think "calories" not nutrition for a while just to try to get him used to eating again !

Regards
Germain
ps does your dad have a wheelchair he can be pushed round in - a change of scenery or being with others who are eating at mealtimes might help ?

 

[botanico]

Hi Jaws

My dad is in a nursing home and is refusing food and drink, my thoughts are with you.

 

[Nell]

Dear Jaws,

Altho' I largely agree with previous posts, I do suggest you consider getting a private physiotherapist to visit your Dad and offer his/her professional assessment as to whether additional physio is (a) practical or even (b) possible.

If you explain your Dad's situation (both physical AND cognitive) to the physio, and explain that you understand physio may not be of value if he cannot understand, then you will probably get a realistic assessment.

You could also ask if there is anything you could do or should not do, to help him. [For example: when I had my knee replaced I learnt the mantra (!) "the good go to Heaven"! This means, step upwards always on your good leg! I've found this invaluable, even two years on!] Altho' your Dad is not mobile, there may still be snippets of nformation you would find useful to help him.

Mum broke her hip the first Xmas after she went into the home and we had private physio which was a success. She regained her mobility to an extent - can walk (albeit very slowly) with a walker.

It sounds to me that the big difference is your Dad is obviously much further down the line in terms of cognitive decline than Mum was then. She was able to follow the exercises, and with the help of one of the Care Home staff, do them between physio visits. It may well be that your Dad has passed this stage.

Lack of mobility is a very difficult thing to cope with, isn't it? It is not just the actual mobility, it is the need to rely on others for personal care needs (such as toileting), increased discomfort or even pain, problems with digestion and bowel movements - the list is endless.

Whatever you decide to do, good luck.