Delirium or Dementia. Mum with broken hip.

[DowntonTrout]

So mum had her second fall in 8 months and broke her hip whist out on a trip with her care home. She has Alzheimer's.

She had an op to pin the bone and is still in hospital. The OT spoke to me yesterday as she was concerned that mum was -

Depressed
Not willing to socialise
Confused
Wants to stay in bed
Has " delirium"

I told her mum has dementia, she is not delirious, this is normal behaviour for mum. Her memory is very poor, she cannot sustain a conversation and when asked questions she will say "I don't know" even for simple things like chicken or pork for lunch. She is incapable of making even that level of decision.

Mum doesn't know what she is doing there, what has happened, why her leg hurts. Her default position is to lie in bed, because it is safe, everything else confuses her. She is scared. But she is always like that.

The OT says they will not release her whilst she is delirious, plus she needs to be able to move about and be able to get to the loo etc under own steam. Whilst the latter is fair enough, she has a catheter at the moment and is still in a lot of pain so finds it distressing to be moved about, I am confused about the delirium.

Her state of mind is completely as it was before the fall. I appreciate they are going on what they see and that as a snapshot with no other information it appears she could be delirious, but they know about the dementia, she has had it 6 years!

Sorry for the length of this. I just don't know what to say to them to make them understand. I am wondering if this is a good time to get mum assessed and whether SS should be involved. She has been in the home almost 12 months and has fallen and broken her foot as well as this. Or should I just leave them to work it out and eventually get sent back to the home. They initially said she would be in hospital for a week but this time has passed and mum is making very little progress physically due to her mental state of mind. She is a long way from being released.

Bizarre. I would have thought hip specialists would be very used to elderly patients with dementia. And most hospitals seem keen to free beds as soon as possible, especially if they have somewhere safe to go to.

It would be reasonable to expect an added level of confusion. There is growing awareness of the impact anesthesia has on the elderly, especially those with dementia. Plus the business of a hospital is really hard for anyone struggling with orientation.

I am sure someone will come along with more expert knowledge of the hospital discharge process. But I think you are right, and also suspect that Social Services may be the best route. They will have links with the hospital discharge people and so may be in a better position to get the ball rolling.

That is weird - my mum had an op recently and had a really bad downturn in her mental performance and they were still chucking her out as soon as they could.

I'd speak to her named nurse, and talk to the home too to see whether they'd be happy to have her back as she is, or if she needs to get physically stronger.

It might be as well to ask for her to be assessed by the falls team too to see if there is anything that can be done to reduce her falls risk.

She is certainly no where near being physically well enough to be discharged. They are attempting to get her mobilised but mum is quite uncooperative. She doesn't know she has broken her hip so all she understands is that it hurts. Therefore she doesn't want to move.

I was prepared for a mental down turn. I have to say it has not been as marked as I expected. I can see it getting worse the longer she stays there though- from a depression POV. I don't really know what to do though. The diagnosis is delirium, it says in her admission notes. If they are attempting to deal with that before they get her mobilised it will be a long wait because her "delirium" is not going to get any better.

When my mum broke her hip they initally talked about amove to a 'rehab' hospital. I assume the aim there would have been to get her moving.

Could this be a solution.

As it turned out they changed their minds at short notice and decided on a discharge home without any adaptations or support pachage in place. My mother too had no idea why her hip hurt and she had a broken wrist which she was not supposed to put weight on.

We ended up buying 5 weeks convalescence in a private nursing home where they did a good job of encouraging her out of bed and taking part in activities
I then arranged for two hours of a daily carer. First to check on her but also to take her out for a walk each day. This not only helped with orientation but provided the ideal physio.

Apparently the hip pain will normally go on for months. There is some sort of spring involved which means the pain should diminish when muscles to counterbalance the spring are built up. Easier said than done if you mum only understands the immediate pain.

Thankfully it wasn't the hip joint, but the bone (femur?) at the top of the leg which they have pinned.

Her care home are excellent and will order her a nursing bed and air mattress when she is able to be discharged. But she needs to be making progress before that can happen.

It is very difficult when she has no comprehension. The conversation goes

"what am I doing here? "
"you've had a fall."
"why am I here?"
"you've broken your hip."
"have I? My leg hurts."
" yes, you've had a fall."
"what am I doing here?"

And so it goes on. But that's a pretty normal exchange for mum anyway. I can see why they thought it's delirium initially, but after a week, with her notes and history and me repeatedly telling them she has Alzheimer's they are still fixated on delirium. There is no UTI or other infection to suggest anything. She was given a blood transfusion because her blood count was low but I believe that's quite normal after an operation.