81yo Dad - broken back in 3 places

[MintyCedric]

81 yo dad fell from top to bottom of stairs on Monday morning - he's fractured his T8, T11 and T12 vertebrae, 2 are unstable but they've run it by local neurology unit who have given the OK to put him in a brace briefly today.

What's really worrying me atm is that his speech seems to have been affected. Afaik there's nothing sinister showing on his MRI or CT scans (had a brain scan Monday as also banged his head and is on Warfarin) and they are saying it's just a combo of exhaustion and dehydration. He has been largely nil by mouth since yesterday after choking quite badly and needing suction. Is now on IV fluids and they're hoping to get him upright enough to eat tomorrow rather than having to resort to tube feeding.

I have no idea what is normal in a situation like this. He was nearly sent home by A & E on Monday and we've not seen the consultant since he's been in so am a little lacking in faith as far as the hospital is concerned (although the nurses have been great).

Has anyone had a similar experience? I'd be really grateful to hear positive stories or advice. TIA.

Oh dear poor dad, that must have given him a fright. Do they know why he fell did he lose his balance. The consultant will see him but they are not there every day, what have the other doctors said, if you want to speak to the consultant just call their secretary. I'd ask why they think he fell, what plans are they making for his sitting up, walking, rehabilitation. When hes feeling stronger and they have a plan in place you could ask for a meeting to discuss what the next steps are, will he need rehab, changes made at home. What is his home situation at the moment.

Thanks for the replies. QT that must have been tough.

He and mum are still together, although she's 80 and they're in a house with stairs and no downstairs loo which I imagine will delay getting him home.

Trying to take one day at a time but it's tough not to think ahead. I'm an only child, single mum and work full time, so it's quite a juggling act.

Has he dementia? The shock will have been awful for him.

He may need thickened drinks - easier to swallow - until he has come to a little.

You need to find out what they plan - operation? Rehab? Physio? Will he manage back at home?

It sounds very difficult. Sending hugs to you.

They don't seem to have a plan at the moment beyond getting him in the brace when they can and doing physio.

Obviously they will have to build this up slowly and when he's not in it he'll have to be flat in bed so God knows how long it'll take.

He's not got dementia. He's a bit doddery mentally and physically, prone to depression and has had several falls over the last few years.

They've done all sorts of tests but never got to the bottom.of what's causing them. He ticks every box for Parkinson's but had a brain scan a year or so ago which they said was clear.

My late Dad had a fall down the stars in 2014,when he was 89. He was put into a brace which he wore constantly for at least 6 months and also had physio. He was on Warfarin and his INR was measured every week ,thanks to a visiting phlebotomist. Like your parents, they didn't have a downstairs loo, so we moved a single bed down to a ground level room and he was given a commode. Thanks to the local multi agency approach (hospital, social services, physio) he had 6 weeks of home care given to him as Mum wouldn't have been able to manage. I cannot fault the NHS on the way they treated Dad after the fall. He had got up to go to the loo in the middle of the night and the suggestion was that he missed the stairs and blacked out for a few seconds. Good luck with sorting things out,it is stressful but can be done. Do not be afraid to speak up on behalf of your Mum and Dad to ask for help. My parents belonged to a generation of "its ok we will manage" but there is no need when help is available .

Often such falls with injuries trigger other issues. My Mum fell last Feb and it has triggered what we think is a form of dementia - she broke her back too as well as hit head and on blood thinners

Have to say we had a terrible time with an initial 9 hr wait for an ambulance whilst she was on the floor having to soil herself etc and being nil by mouth per instructions from ambulance operator we then got into hospital and hallucinations and psychosis followed with poor speech, co-ordination and more. We were discharged next day with no diagnosis having to go back to A&E about a week later supposedly for a booked scan - another 6 hr wait in a chair and another admission, discharged again after an xray and head scan but no diagnosis.

THEN about 3 weeks after the accident and finally having a diagnosis of the break having had to ask for results 6 times as they were lost in the system, she had a massive "episode" where I held her in my arms whilst she fitted for 40 minutes or so and then finally came out of it as the paramedics arrived and we ended up waiting in the ambulance for 8 hrs to get into A&E . We had about 6 weeks in hospital with extreme psychosis for around 3 weeks followed by utter bewilderment and frustration. After sterling research work by my sister we persuaded Dr to look at calcium (she has a form of osteo it appears) and magnesium levels and she was critically low on those fronts and vitamin D.

We are still fighting to sort things for her we are awaiting a diagnosis on the brain front basically exacerbated or triggered by the whole experience. Things have improved massively from the earlier days and only the other day her voice was sounding the most "like her" I have heard for a year or more (She had a TIA the prev Oct). We have been told any operation or fall or illness will likely cause a form of regression cognitively.

So I think if there is minor speech disturbance and noticeable deteriation cognitively - get them to look at it, consider magnesium issues but most of all get him home asap and do care at home in familiar surrounds. Get the home assessments done and adapt NOW before they deteriate further (so get aids in that may seem over the top now but the more they get used to using them now the easier it will be later - ie Mum struggled with new kettle which dispenses hotwater as she was familiar with a normal flick it on and pour kettle and even though the process is check water, check cup size, insert cup and press button we had to have an instruction sheet for 6 mths) but she couldn't lift the kettle and the lack of arm strength meant spills.

Mum is mid 70's and was actively driving and busying around doing holy communion for the elderly around her, yoga, gym etc

Also remember not everyone is built for caring especially partners with their own health issues, look at getting some help in for cleaning and meals if necessary for the short term - if you find a couple of people locally that he can get to know longer term this will lighten any burden. You can get temporary blue badges which can help with hospital appts, Drs etc or just get out the house outings. Also look at if there are any other bnefits claimable to help with costs such as carers allowance for partners which can help with things like cleaning costs

RB that's really helpful and I'm so sorry you've had to go through all that...sounds a million times worse than our situation.

Mum will be desperate to get him home as soon as it's feasible. Depending on his condition she's looking at either putting the house on the market and moving to a bungalow (bit tight on budget but doable if only she'll compromise a bit!), or getting equity release to put on a downstairs shower room and second hand rail or stair lift. She also talking about paying off a chunk of my mortgage so I can reduce my working hours and be around for them a bit more.

Hospital have already mentioned OH and care package for when he leaves.

I will definitely ask about supplements, especially as he's not eating at the moment and hasn't managed much even when he was being fed. He's a fairly small man so doesn't really have the reserves.

He seems fairly lucid when he is able to speak, it's getting the words out which is an issue. He is quite mumbly anyway but definitely normally like he is at the mo.

I so hope you manage to move forward soon with your mum's care. It's so sad and frightening seeing them like this.

My dad hasn't had a brilliant quality of life in recent years, largely due to lack of confidence re falls and continence issues I suspect. Had started putting things in place to try and get him out more so he's having more fun and mum gets a break, but looks like they'll be on hold for a very long time, although he did say yesterday he wants to go for a curry when he gets out!

not normally like he is at the mo re speech

Hi op,

So sorry to read of your Dads fall, what a shock for all of you. Dehydration can cause serious confusion in anyone but especially the elderly. This could account for speech difficulty. Are they giving iv fluids?
Once he has a spinal brace the physios will be keen to get him sitting out of bed for short periods, hopefully for some mealtimes too.
Drinking from a straw is safest when lying down, small frequent sips are best.
You know what's normal for your Dad so keep advocating for him and let the staff know what your concerns are.

I hope things improve soon, it sounds really stressful.

Thanks sea.

Neuro unit have come back and requested yet more x rays before they make a treatment plan. Dad said when they did one of the scans the other day it was really painful and distressing...and that 'if I pass away while they're doing it, tell everyone I loved them even though I was a grumpy bugger' .

Staying with him until they're done althou no one seems to be in a hurry - quelle surprise.

Today's doc actually showed be the diagnosis from previous scans etc and it's actually 4 broken vertebrae and a fractured rib .

Debating getting touch with PALS tbh.

Minty, is he getting fluids? It sounds like a really distressing situation.

Has he had a speech therapy (sometimes called SALT) assessment? If he choked to the point of needing suction, and has been placed nil by mouth because of this, he really should be assessed? And has the dietitian seen him?

What was he eating/drinking when he choked?

What does the change in his speech sound like - is it unclear as if he can't get the words out, or husky like laryngitis, or both?

How does his mouth look? It's bound to be dry, but is it sticky, or is there white coating on his tongue, or white spots? He might have thrush which won't help. Ask them to look? If you are there a lot, ask them to show you how to do mouth care? It's not hard but there are a few things to consider in doing it. If they tell you it's fine for you to do it but don't show you, PM me and I will explain.

Make sure he is properly measured for the brace. MIL was in one for months that was too loose, care home kept raising concerns. She wasn't in a care home before falls but came out of hosp needing major care care package sadly.

Thanks Pat (love your name...as would Dad - huge Corrie fan!)

He's had the SALT round for the last three days. Yesterday he gave his mouth a good clean whilst I watched (he had oral care on his board but don't think the nurses had done much tbh), and has left the kit there so I can have a go if needs be.

He's given the OK for thickened liquids and pureed food so he managed a bit of lunch and dinner yesterday and had 2.5 glasses of water and 2 cups of sweet tea with me whilst I was there. He also manged to take his regular tablets with thickened water instead of having them crushed.

Seafour I'm not sure he was getting enough fluids initially but they had him on 16 hours of IV fluids up until yesterday lunchtime, by which time the SALT had seen him and he was drinking again.

They are pretty sure it's a combo of trauma and lying almost flat that's causing the issue rather than anything more sinister.

He also has plenty of movement and sensation in his legs so they are confident they'll be able to mobilize him (eventually!) and that will help with everything else.

Just off to get some bits to make him a thick chicken soup for lunch (ordered a pureed meal for him, but he had the same last night and didn't like it, so I've asked them to change it but want to be prepared if it doesn't happen), and will get some osteocare liquid (for all the vitamins etc you mentioned RB...thank you) and squash as he really doesn't like the plain thickened water!

1hello I'm hoping to see him in the brace on Monday - have arranged to go into work first thing for a couple of hours, then walking round to the hospital with my laptop and working from his bedside so I can make sure I'm there. Work have been incredible which is a massive weight off.

I'm also so grateful for the advice everyone offering on here. Feel absolutely clueless and helpless so even little things like the vitamins suggestion are really helpful.

What are their stairs like. If they are a straight flight, a stairlift can be very quick and easy and can also be reconditioned so cost can be even lower. If finances an issue you could approach charities, for example, if he did national service/army then SSAFA might fund an urgent stairlift. Also check with local council as we were told recently about a new Hospital Discharge grant, which is not means tested(like most council grants are) and can be used for urgent equipment/adaptations to expediate discharge fom hospital.
A stairlift will be much cheaper than a house move so unless they were planning to downsize anyway I would go with that.
I wouls also ask the hospital to trial a convene catheter at night as sometimes patients will be allowed to sleep without the brace providing it is on when they walk. This is ok for those who sleep through without needing a wee but most elderly people are up at least once at night. A conveen is like a condom draining into a catheter bag so is non invasive and some people with poor mobility just have them on at night so they can sleep through. (he may have to wear the brace all the time though...see what consultant says)
I agree with getting him home asap and there should be up to 6 weks of NHS funded short term reablement help available to assist with personal care etc

I'm sore Op. I hope the position becomes clearer soon.

RB that was really poor care.

Sorry

Sounds like things are moving forward. You're a great daughter.

Thank Pat...I'm trying!

Mum.made a comment today about how much better at coping I am than she is.

This Is because she didn't see when I'm not!

My mum fell while on holiday in Malta a few years back when she was 79 and broke her back in two places. Thankfully she was well insured and after 10 days in a private hospital in Malta she was flown home business class with door to door assistance. She had a brace made for her in Malta that she had to wear every day and after a couple of months of pain killers, rest and very gentle exercise she was ok. She had some physio but essentially there was not a lot of treatment other than time that helped. She was initially disorientated and poorly after her fall as the shock and stress made her not feel like eating and drinking so she got was a bit dehydrated and weak.

She was diagnosed with osteoporosis and the fall has meant she is now extra careful when out and about and she now uses a walking stick for extra support. The only long term affect was to her confidence particularly if she goes out in winter, she does get backache when she has had an active day but thankfully she has retained her independence and has had no further falls.

Hope that your dad makes a speedy and full recovery.

Thanks sunburst - I'm sorry you and your mum went through that but your story is really encouraging.

It's so hard to take it one day at a time when his progress seems so slow. Mum is not coping very well on her own at all, and I have to go back to work next week (although they are happy to be very flexible about how/where/when I'm working) so I think that's going to be stressful in itself.

Went in briefly today as he had some friends visit this morning and was very tired. Hasn't eaten particularly well today and they've got him on IV fluids again. Manage to get him down for his x ray but wasn't able to stand long enough for them to complete it so they are going to get the physios up to work with him tomorrow and try again.

If the word finding difficulties continue it might be worth asking for a repeat ct brain scan, if older people fall and are on anticoagulant drugs they can have a bleed which doesn't always show on the initial scan especially if scanned early.