...to get mum out of her hospital bed

[marriednotdead]

My mum had a spectacular fall on ice 12 days ago, and broke her right hip and arm. They have pinned her hip but the break in her arm is too high to plaster so it's just in one of those foam slings and will apparently set on its own.

She was moved to a rehab unit on Sunday as her broken arm prevents her from getting up using a Zimmer frame which normally happens within a day or two.

Every time they attempt to get her out of bed she creates until they stop. I was there today and she is clearly frightened but is adamant she will do it 'in her own time'. She's starting to get panicky so maintains she is dizzy/faint/in agony if they manage to get her to do any movement.

She's not even left the bed to sit in a chair and is still using a bedpan. This is a normally active 70 year old who was on her way to work!

However, despite admitting her arm hurts more than her hip now, having a dose of morphine before the physios started, and shrieking as soon as she stood up, she was leaning on the broken arm without a murmur as they helped her get back into bed!

Clearly the blocks are more mental than physical, something she will not admit. She voiced to my dsis that they couldn't actually make her do anything, which got shot down but she is like a belligerent preschooler.

We love her dearly and want her well but she simply wants to lay there and pretend it's not happening.

Everyone is trying to motivate her and be positive but we and the physios are very frustrated and don't know how to help her progress.

[sneakybeak]

I'm an OT - try not to panic too much. Physios and OTs should know how to progress. This should be a combination of approaches - medical i.e. is the pain relief correct? Compensatory - equipment/techniques when all is not well with a person. Psychological - if she's frightened she may need some relaxation/counselling type input.

This is not my finest post, but it shouldn't be that unusual for the Physios. I see people like this all the time in our ward!

[marriednotdead]

I spoke to the physio before and after today's 'performance', and she's going to see about relaxation techniques. She witnessed the leaning on the broken arm but mum is so wily and thinks she's got us all fooled.

She talks a good talk but seems to be in complete denial that she will have to move for this to get better.

Am so frustrated- gah!

[sneakybeak]

With clients who seem to be making no progress and there seems to be 'one problem after another', we sometimes hold a case conference.

Everyone gets together and basically plans can be made.

It can be quite an effective way of moving things forward, but this is usually done after a few avenues have been exhausted, so in your case not yet.

[marriednotdead]

Thanks. I know they have reviewed her meds. Mum told me that her blood pressure dropped yesterday when they tried to get her up. Physio dropped her in it today by reminding her that her BP was fine!

I guess mum is lying so that she doesn't look like such a wimp but I felt quite ashamed

[sneakybeak]

Fret not - it's bread and butter for the therapists!

[marriednotdead]

Bump for the morning crowd.

[jollyoldstnickschick]

I think it would make your mum nervous and scared and its quite understandable she is apprehensive,but as you say she is an otherwise fit and active woman then it wont be to long before she is 'fed up' of being fussed over and in bed.

I wonder if you could encourage her to do slight movements with her arm jigsaw puzzles perhaps? and try and tempt her out of bed for a clean nighty or a hairwash?.

[madamy]

It might sound cruel, but she can't sit on a rehab unit forever. If she's not going to participate in the rehab, then she needs to think about alternatives on discharge. Maybe she needs to hear this if the softly, softly approach isn't working?

Have you thought about setting some goals, both longer term and short term. For example - thinking about discharge from the rehab unit - does she want to be fit enough to go home, if not what are the alternatives? Assuming she does want to go home (!), then what does she need to be able to do to get there?

[marriednotdead]

She seems to not be that bothered about her appearance but although she was always clean and tidy, she never wore make up and cuts her own hair. We've freshened it with dry shampoo, hospital will wash it if she wants but she cba...

She reckons she wants to go home, back to work etc. but when you point out that she'll need to get moving she reverts to 'I just can't yet' negativity.

She's normally a heavy smoker and even that's not motivating her.

[marriednotdead]

Madamy, they can't and won't discharge her when she is unable to do basic care/toilet herself.

[CMOTDibbler]

I think what Madamy might be saying is a bit of hinting along the lines of 'oh dear, I'm so worried that you aren't going to be mobile when they want you out of here, perhaps I need to go and look at some nursing homes' might not go amiss. Sounds awful, but maybe it would motivate her a bit

[marriednotdead]

I'd have thought the lack of stimulus would have shifted her by now, she's a very intelligent woman who only lasted a few months in retirement before going back to work to keep her brain ticking.

I'm wary of saying anything too negative as she sucks it up and gets worse. Mind you, I sarcastically pondered whether I needed to book her funeral yet.

But we were joking yesterday about our annual holiday and she declined bungee jumping but suggested abseiling might be possible!

She talks a good talk, deserves an Oscar for talking up her intentions. The present negativity is alien and horrible though.

[Nilgiri]

Sounds like there's something else going on.

She's an active 70 year old who is still working. You say she normally gets up with a Zimmer frame after a day or two, so I presume this is after previous injuries which she hasn't been too fazed by. And she's a normally clean and tidy person who is now not even letting the staff wash her hair.

So all of this is completely out of character.

I think I'd be looking at a variety of things.

? Is there something embarrassing that she's covering for - eg if being discharged means you will have to wipe her bottom for her till she has her arm back in use?

? Does she have another, perhaps embarrassing, injury that she's keeping quiet about and hoping will fix itself?

? Is there something troubling her about being at home - it might have been grumbling along for a while and she's reluctant to go back to it?

It's also being recognised that a thump on the head can cause quite subtle brain injury which even months afterwards can be causing mood and behaviour changes (Richard Hammond had a significant injury, but people in whiplash-type collisions have reported similar long-term probs).

Sorry, the last isn't helpful in practical terms, but might perhaps explain it?

[QuintessentialyHollow]

What would you say if you tried to tell her that as she cannot sit in rehab you need to look into care home options for her? If she really cant get up, you need to sell her flat and get her a more permanent care solution?

(Not that I think you should go ahead and sell her home, but to see what she says if you start taking your word for it that she really cannot get up)

[marriednotdead]

Nilgiri, sorry if my posts were confusing. People with the same injuries as mum are normally up out of bed within a day or so, she doesn't usually need anything to assist her walking and would run for a bus if she had to.

She lives with her partner who is in reasonable health. They have a decent sized house which he does the majority of the housework in (I have just discovered) in deference to the fact that she goes out to work p/t and he doesn't.

She knows we couldn't sell the house or anything like that but a nursing home will become a real possibility if she doesn't start co-operating.

I just spoke to the physio who agrees that she does not appear to be in any real pain now, just discomfort which is natural. She won't give up but is struggling to get past the barriers mum's putting up. It transpires that the (previous) hospital were taking her to the toilet in a chair so the bedpan is a regressive step.

She has a strange relationship with her DH, he was always domineering in the past but the tables have truly turned; she snaps at him constantly despite his best attempts to make her happy. Maybe she doesn't want to live with him anymore, I just don't know and she won't be honest about anything.

[suburbophobe]

Hi Marriednotdead,

I'm sorry to hear of you all having to go through this (and that includes your mum!).

Sad to say, that's how it started with my mum, the fall and dizziness/fainting/confusion while "putting up a front" may have to do with each other....

Is she getting forgetful? Talking about abseiling when she just broke her arm and leg...

You also say she cannot do her personal hygeine care either...

I.e. could it be the start of Alzheimers?

I'm not saying this to be mean, but you all need to keep a watchful eye out..

[jollyoldstnickschick]

I wonder if perhaps your Mums having a 'break' from home?
perhaps her marriage isnt happy,perhaps shes enjoying 'time out'?

could she stay with you for a few days when she comes home? is there any long term plans you could encourage?

[marriednotdead]

Thanks suburbophobe but no chance of that. The abseiling thing was a joke, we all have quite a black sense of humour. The first thing we told her was that she'd failed her Dancing on Ice audition . Her memory is phenomenal, you'd pay to have her on a pub quiz team and she's as sharp as a tack.

jollyoldstnickschick, I think there is an element of that, dsis and I were mulling it over earlier. She is giving her DH hell every time he opens his mouth, nothing he does in right although he assures me she's not usually this nasty to him. I hope not, this is not the mum I'm used to and I don't like the one I've currently got at all

It's hard to sympathise when she's behaving so badly...

[CiderwithBuda]

Sounds like she is scared. It's probably knocked her for 6 and reminded her of her age etc.

Could she have had a mild stroke? That can cause personality changes.

[marriednotdead]

She's definitely scared, I'd not thought about the personal mortality concept but you could be right. No sign of a stroke, everything else seems to work (including the broken bits that she won't move).

[frumpet]

I feel really sorry for your mum . She has gone through a terrifying experience . She needs reassurance and understanding . How many of us have been in a RTA and then been a bit jittery in cars after that for a while , or fallen off a horse and been nervous about getting back on?
Yes she is been silly in that she wont get better without moving , but being scared is acceptable in her posistion .
Remind her that physio's do not drop people or let them fall , they are trained and will keep her safe , tell her the paperwork they would have to fill in if she did fall would be horrendous , make a joke out of it .
She knows she is being silly , which is probably why she is so angry and is projecting that anger onto her partner.
How you deal with it depends on your relationship , but try to go easy on her .

[marriednotdead]

Some progress today!

Her DP finally pointed out to her that she needed to start moving if she ever wanted to get out of hospital. She went nuts at him but later asked her to bring in undies. As she tucked them under her covers the penny dropped for him that she must be able to put them on herself.
Later, dsis visited and mum asked for a bedpan. Dsis feigned surprise and asked in front of the nurse why she wasn't getting up like in the original hospital, then deliberately cut short her visit rather than stay while she used it.

Today, she has asked for her favourite soap and has been sitting in the chair!

I feel sad that we have had to be hard with her, but it seems to be having the desired and neccessary effect. Fingers crossed for the next few days...