Physio after broken hip

District nurses are brilliant. They can refer on if needed but I suspect your mums nursing needs are the highest proirity atm, so you’ll be in good hands with them.

A bit of a dip when first home is normal, the move from hospital to home can be a big one.

is it a Mackworth she is using to transfer or a Molift? Either way at least she is getting some time on her feet, even if brief. Needing double up care is unusual and suggests either her transfers are poor or she is hard to turn in bed and needs 2 people?

it is still quite early days. A private physio isn’t a ‘bad’ move, they can help prevent deconditioning but I do feel it may also be around managing expectations but unfortunately some may take advantage and keep working with your mum despite no change in her presentation.

personally my focus would be on occupational therapy. They can assess your mum and how she interacts in her home environment. They try and reduce barriers and ensure your mums is leading the best quality of life possible and interacting with her environment . They can look into her transfers and she is the need for care can be reduced in anyway, the initial aim would be to reduce to single handed care.

that said i don’t think it should be underestimated how traumatic a hip fracture can be. You also have different types of breaks and different types of hip operations, some will heel better than others. Try not to compare recovery to those who have had a planned hip operation (elective).

Unfortunately outcomes in terms of full recovery are poor. You may also be dealing with other issues such as post op delirium, fear of falling, reconditioning from 4 week hospital stay etc. again an occupational therapist can help with this.

i would question why carers feel she needs a profiling bed. Is it concerns around pressure sores? Or is your mum unable to sit up to eat and drink? If so she needs one urgently to avoid the risk of aspiration. It may also be compatibility with the transfer aid, again Occupational therapy is your friend here. If nursing / eating related you need direct nurses asap.

the surgical management depends on the type of injury and the patient's baseline physiology. A hip replacement is not always the appropriate treatment.

spent a lot of years anaesthetising patients with broken hips....it's tricky for patients with dementia. As per @AnnaMagnani , the wanderers may well rehab themselves a bit (so long as they don't fall over again) but if motivation/energy/focus/nutrition etc are lacking as part of a cognitive impairment rehab potential is limited. It used to be that you'd anticipate a step deterioration in mobility for in the patients starting from a frailer baseline. A lot will also depend on other medical issues - it's often an injury that happens as a symptom of other medical issues and those may become the limiting factor in rehab (the reason for the pending CT scan may be significant here). Ultimately, a broken hip is still a life threatening injury despite progress in surgery, anaesthetics and peri-injury/operative medicine - for some patients rehabilitating mobility is a massive ask.

Have missed that she already has 4 double up calls a day.

Unfortunately OP I think you need a physio who is prepared to be very blunt with you about her realistic rehab potential. It may be a lot less than you are hoping for.

So she’s having doubled up carers 4 x a day? How is she transferring from an to b atm? With what equipment and with what level of help? How long does she sit out for? What type of hip operation did she have? IM nailing, DHS,THR? Is pain well controlled? Is she eating and drinking sufficiently? Does she have any specialist equipment, profiling bed, tilt in space chair etc? Is she able to follow simple instructions? How long ago did she have the op?

people do tend to recover better at home, especially those with dementia. But depending on the answer to the above questions, will incite the level of rehab she will tolerate / be fair to put her through.

I have had a couple of elderly relatives with hip fractures , one also had dementia.

What I suggest is that you make sure she has a bed sore prevention mattress and a bed sore cushion as if she is in bed for long periods or sitting she is at real risk of developing bed sores. You can get these on the NHS but they only tend to give them out after the relative has got bad sores.

My relative with dementia ended up with additional falls and injuries because the dementia meant he did not feel or understand the pain in his hip. Hope that is not relevant to your situation.

If funds are not an issue some private care homes have physios and will do a daily regime in the care home and help get her continent again and fit enough to return home - just a thought as others are right in saying that it is repeating the exercises that is important and your father may struggle with that and most carers will say that physio help during their care time is outside their scope.

Yes yes yes.
motivate physio as much as she can afford. Much more hands on / personal than most nhs physios and keep it going long term if you possibly can. apart from anything it’s be to one social time that isn’t family which is do beneficial

It's pretty normal for patients to do more for strangers than their own family. You need a no nonsense type carer.

I'm on a couple of FB groups. Mobilise is one, the other is Carents Lounge.

I do snooze them from time to time as I find it depressing to see the scale of the lack of support from the State. We really are abandoned by SS and the NHS. At least we are all in the same boat, small comfort though.

They are a good source of support though, if sometimes overwhelming.

Private physio all the way.

A relative broke her hip and when clearing her papers after she died, I stumbled across a letter which said the cause of her back pain was ‘insufficient rehab’. It broke my heart to read it.

It is very difficult to do physio with someone with dementia as most of the work is done by the patient when the physio isn't there.

If the dementia has caused loss of motivation or they aren't going to remember to do their exercises rehab will be difficult.

If she has the sort of dementia with a drive to wander the whole time however she may just rehab by herself.

Carers to implement physio advice daily is going to be the best way to spend your money.

I'm glad you are booking private physio, definitely the right way to go.

My mother fell and broke her hip when she was in a dementia care home. After surgery and ten days in hospital, she went back to the care home and the carers followed the physio advice and got her mobilising again. Within six weeks she was walking as well as before she had the fall. So your mum may walk again but at this point she really does need physio help. If she sits in a chair all day she will lose muscle mass as well as losing the sequencing ability to walk. Best of luck.

I'm sorry for you and her. I hope a physio can help her get a bit more mobile. I'm presuming the incontinence isn't directly linked to the hip surgery or recovery?

Absolutely private physio, the earlier the better! Longer they are less mobile, the more muscle wastage, the more fear.
Can look on Chartered Physio website to find them near you.

Did the physios from the hospital not give her any exercises for home? If she's still under an ortho trauma consultant they should be able to instigate a physio for her?

It's true it might take a while so if you can afford it then maybe do go private, at least initially. They are usually about £100 p/h or more for home visits I think.

Is she able to get to the bathroom and use toilet unaided? Could she do that before?