Help hospital did not give my Mum a chance

[tialeanne]

My mother is 85 years old has dementia, parkinsons and epilipsy, she was recently admitted to hospital following a fall in which she broke a hip. We were told she would undergo surgery and then a course of phyiotherapy probably starting the next day she should be in hospital 2 -3 weeks. She was in the wrong ward to begin with so that was the excuse for the first four days for no physiotherapy, she was then moved to the right ward and I spoke to the physiotherapist and she was very pleased with my Mum, said she had a positive attitude and was very willing had walked from the bed to a chair, not sure if she had one or two sessions, however she was then moved again to a respite ward and no more physiotherapy for six days, the excuse this time was she was resting when the physiotherapist wanted to work with her. Following my concerns about the way she was being treated and requesting to see someone on the ward the next day, before this could happen she was moved quite a distance to another hospital. The phsiotherapist at this hospital said as she had had vey little physio in 11 days it was doubtful she would have any mobility they would try but probably too late, although they did continue to work with her for a while but she was becoming very distressed so it was decided after a couple of weeks not to continue.The original hospital basically are saying the SLIGHT (sorry but 4 days then 6 days is not slight) delay, should not have had any affect on whether my mother would have gained any mobility). However if she should have had it from the day after, even in someone without my mother's health problems this I would think could have a significant affect, especially as the physiotherapist was so positive about the initial treatment. The fact my mother has dementia I feel means that she doesn't realise she should be walking and that is the whole crux of the matter. The family also feel that as my mother had dementia the staff could not be bothered and basically left her in her bed as they felt she wasn't worth bothering with. I have a meeting with the hospital on the 4th August and wonder if there is any literature or published information to help prove that the fact that as my mother wasn't given treatment straight away meant that due to her dementia she was then unable to understand what she was suppose to do because the routine of doing that was no longer there. I do realize that she may not of walked but feel that she was denied the opportunity of at least some mobility, especially as the physiotherapist was so positive after the first treatment. This has meant that my mother has had to be moved from the home she chose and was happy in to another one which is quite away and means I visit less often, It has also added considerable stress to my mother and myself in what was already a very stressful time. I would welcome any guidance on this

 

[Weatherwax]

re- help, hospital did not give my mum a chance

Hi, sorry to hear you had such a distressing time over the last few weeks, it sounds as though you have done the right things to address your concerns by raising an issue and arranging a meeting with the staff. I don't know if anybody on this forum will be able to answer your question about the delay in receiving physio input and your mum's lack of mobility, everyone is an individual and every case will need to be examined with all the details to hand.

I hope you get the answers that you need to resolve this issue, and wish you the best of health and happiness for the future.

Kate

 

[Vonny]

Hi Tialeanne and welcome to Talking Point.

It's a difficult call because everyone heals at different rates and it could be that your mum may not have recovered her mobility anyway.

I've done a bit of googling about the expected frequency of physio following a hip replacement op, and have come up with this from the North Devon NHS

http://www.northdevonhealth.nhs.uk/patientinformation/physiotherapy/after_total_hip_replacement.htm

Again, it is difficult to say if a physiotherapist could achieve all these exercises with your mum. However, the expectation that on days 1 & 2 out of bed the exercises should be hourly, and from day 3 at least 3 times a day does seem to be at odds with your mum's exercise routine with 4 and 6 days missing. I would have thought that even with dementia there would be scope for some of the simpler exercises.

If I can find anything else I'll post again. Good luck for your meeting with the hospital on the 4th August.

Vonny xx

 

[snooky]

Hi,

I sort of know how you feel. My dad had a minor stroke 3 wks ago and had some physiotherapy to start with, but then got pneumonia and they haven't tried anything for 2 weeks since, because they say he wasn't responding, etc, etc. Well, if you've been so poorly that you had pneumonia I don't personally think you would be up to responding to physio, but now he is better from that they are saying he won't get any better from what he is now. He is not walking and eating liquidised foods. Well, I think he should be given the chance now he is free on infection, to try again, but it seems to me the Docs are quick to dismiss people. I explained that he was mobile before and they seemed shocked by that and could obviously only see him for what they think he is now, but I know different, as I am sure you do for your mum.

My advice would be get them to try again, surely it is never too late to try. It is frustrating for you that they didn't try earlier, but it must be worth trying now to see if there could be some improvement.

I think we as family members know our loved ones best and sometimes Doctors just don't see what we know. They just see the now and not what may be possible if only we try....

Snooky

 

[TinaT]

I was in my late 50's when I broke my hip and had to have a full hip replacement. Because I had to go private (I lived in Spain at the time) I could only afford to stay in hospital for a day and a half after my op. I would have also had to pay for any physiotherapy which I couldn't afford so I was given a printed sheet of excercises to do.

I still remember some of them which you might be able to try with your mum (although she is older and may not be able to respond to instructions because of her confusion) but I hope these help you to do what the hospital should have done, but didn't! Some of the excercises I did are on a website which may be helpful to you: http://www.thevideoclinic.net/index.php?option=com_tvc&view=injury&id=163&video_id=195

The video's show excercises which are for immediately after op, two weeks after the op etc., etc., but these are the ones which I think could give your mum some excercise whilst she is sitting or lying down and may still be beneficial for your mum.

My mother broke her shoulder last year and only had physiotherapy 6 months afterward. The physiotherapist only came for an hour each week for 5 weeks but I do think it did help her with the stiffness and pain. She couldn't have physio before this as her shoulder took a long time to stabalise enough to do any excercises.

I'm glad that you are fighting your mum's case. It won't help your mum but hopefully will jolt the 'accepted' idea that older people asnd people with dementia cannot be given physio. They CAN! It may not lead to walking again but it will certainly help prevent stiffness and pain resulting from this even if it is very much later than it should have been.

xxTinaT

 

[Margaret W]

This is an amateur response and to be ignored by anyone with any better information. I cannot see how lying idle for 4 or 6 weeks helps anyone unless they are needed to rest for their wellbeing. Light exercise is surely beneficial, to be started as soon as possible after any surgical procedure, be it just walking, or even bed exercises involving the arms and legs - lifting and stretching, pushing up, even breathing exercises. It seems common sense to me.

After 4 weeks surely mum (without a sound medical reason to the contrary) should be able to be accompanied to use a walking frame, or at least get in and out of bed to sit in a chair. Just shuffling to the toilet is exercise in itself, and provides some dignity for the person.

If the patient has dementia, they will soon lose the knack of doing things, so this treatment should be started earlier than those without dementia.

Sorry to be on my soap-box but I feel that the NHS too often take the easy way out. I'm not slating the NHS, there are lots of good hospitals but sadly far too many who don't do the job.

Tileanne, I have nothing formal to give you, but at your meeting on 4th August I would at least be asking why mum was not given "bed exercises" to maintain suppleness and strength and perhaps ask them how they justify a gap of 10 weeks as contributing to her recovery. Bit sarcastic to put that in, but puts the ball in their court.

Let us know how you fare.

Margaret

 

[Sandy]

Hi tialeanne,

Welcome to Talking Point (TP).

The details of your mother's struggle to recover from a broken hip is very distressing, but to anyone who has read posts on Talking Point for some length of time, not entirely surprising.

Now how much of that is down to the lack of immediate physio in hospital and how much of it is down to your mum's own mental and physical condition - no one on this forum can say.

Does your mother suffer from any other conditions that would affect her mobility - such as Parkinson's or arthritis?

It seems that one of the most difficult aspects of getting people with dementia active again after surgery is the effects of the general anaesthesia. Many people have noted that it can really set someone with dementia back mentally and physically for some time:

http://www.rcpsych.ac.uk/college/faculties/oldage/dementia.aspx?page=2395&sId=40

That might have had some impact on your mother's readiness for phsyio:

the excuse this time was she was resting when the physiotherapist wanted to work with her.

When the physio was attempted at the second hospital:

The phsiotherapist at this hospital said as she had had vey little physio in 11 days it was doubtful she would have any mobility they would try but probably too late, although they did continue to work with her for a while but she was becoming very distressed so it was decided after a couple of weeks not to continue.

were you or any other member of the family able to observe these sessions and see how your mother was reacting? Has there been any further attempts at rehabilitation now that she is in her new home?

Take care,

 

[Tender Face]

There is no excuse for being on the ‘wrong ward’ – physios are not attached to wards ... they are assigned to patients ......

Of course your mother wouldn’t remember instructions ... my own mother had a hip replacement a couple of years before her dementia diagnosis .... the physios frightened her by their persistence when she wanted to ‘rest’ and she was quite uncharacteristically abusive to them at times (we understand why now!) ... and obviously telling her to do anything she should was met with abject awkwardness if not refusal ..... but they persevered ....... I do feel for the physios in the hospital environment – but I do feel they should recognise the challenges of someone with dementia (forgive me for drifting into Utopian world!)....

Have you been forced to change your mother’s GP by this move? They should be first port of call for help and assessment for outreach services if the new home does not provide them under nursing needs ......?

Karen

 

[Sam Iam]

Hi Tialeanne, I am only a physiotherapy assistant (nhs) and in no way qualified to answer for you Mums case and good for you re the meeting.
The physiotherapists where I work are assigned to a ward and treat the patients there, no matter what ( I work in care of the elderly) patients are assessed and treated BUT when a person with dementia refuses treatment they cannot forced into treatment as this would be a form of abuse.

I can assure you it is frustrating when a person refuses
treatment
I am currently involved in the rehabilitation of an elderly lady (broken hip) with dementia and we work hard to ensure the lady is relaxed and happy before the physiotherapy starts, holding her hand or if she wants a cuddle which I have no problem with at all.

There are places where the staff are all mouth and no action and there are good places helping people to regain/keep mobility after hip replacements, strokes, parkinsons, dementia's and many debilitating illnesses.
Iam proud of the people I work with and the treatment they provide, last week I cried with a lady who took her first wobbly steps after 9 months of illness following a stroke, everyone thought she had "missed the bus re walking again" but the physio involved in her care kept plodding on and between them they succeeded.
I hope you get a good result for your Mum Tialeanne as no one no matter who they are deserves to be neglected in any sort of care enviroment.xx
I am not sure but I think you can request to read your Mum's notes that will put the wind up them for this is surely what they deserve.
Best wishes

 

[nbfb]

Dear Tialeanne,

I have recently trawled through the literature and there is not a huge amount out there. I did ascertain that dementia patients take on average 12 weeks of physiothereapy to regain mobility - the average for a non-dementia patient is 3-4 weeks. This does not hold true for all patients; many will never regain their mobility as they have problems following instructions, forget how to do the exercises and may become distressed when prompted to do something that can cause them pain.
I must stress that I am only a carer and my own experiences do lead me to feel that the cost of rehabilitation, hospital bed blocking and lack of services for cognitively impaired patients means that in reality hospitals don't seem to know what to do with a bed-bound dementia patient. In our own situation we feel that they would quite like someone to take the problem away. The dementia assessment unit(where my mother-in-law fell six weeks ago) do not want her back, the hospital don't want her and we are left with what? A meeting in two weeks time. Should be interesting.
I have found these for you, you decide if it suits your needs or not. Should you wish to read more from article 2, please send me a private email message and I can let you have the full text. I hope that you get some sensible answers to your questions and that your mother improves.

Kind regards
nbfb

1. "Maintaining good health for older people with dementia who suffer neck of femur fracture". PSSRU Research Summary 44, October 2007http://www.pssru.ac.uk/pdf/rs044.pdf
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2. This paper (below) evaluates the most recent studies on the topic. Full text not available from here.

Reviews in Clinical Gerontology 2008, 18;53-64
Do cognitively impaired patients benefit from rehabilitation?
Lynn Poynter et al.

Abstract:
Rehabilitation in broad terms is a process aimed at restoring a person's functional capacity particularly in relation to activities of daily living. Studies have shown that hospitalization of older patients is a major risk factor for an often irreversible decline in function, and that functional decline from baseline occurs as early as day two of admission. Rehabilitation is therefore often required for older patients following an admission to an acute hospital. Older patients admitted for rehabilitation are more likely to be functionally impaired and are more medically complex than younger patients.