Pelvic fracture in 90 year old

[StrawberryPot]

MIL fell over today and has fractured her pelvis but apparently it doesn't need any intervention and she 'should be allowed home tomorrow'. DH is currently with her in A&E and it took 2 nurses to get her to the toilet.

I'm fretting about how we will manage this when she's home as she needs the loo 2 or 3 times a night. She lives with us but in a separate annexe. While we could take turns to sleep on her sofa, DH is about to have an op on his arm which he injured quite badly and I have back problems so neither of us is in a position to be lifting/supporting her.

Does anyone have any advice? She's desperate to come home poor soul but I just don't know how we will manage her toilet needs.

Didn't want to read and run - best advice I can give is to get your DH to emphasise that although you live on the same plot of land/property, she is not safe to be discharged home without a care plan in place,

They should be able to discharge to a care home for respite and for recovery, as a halfway house kind of thing - so she has extra support whilst healing, and then home from there.

It will be difficult to say you cannot care for her, I appreciate that (been in the same position), however it is in her best interests, and last thing you (or the hospital) want is a failed discharge or for her to have another fall after discharge

I agree that it needs to made clear that she lives in separate and independent living to yourselves, and requires respite care to be able to return and be independent again. My elderly nan told the discharging planners that my mother lived with her and that my aunt also visited daily- complete lies! I would check exactly what has been said to the staff in terms of ongoing care and support- just so she can return home.

Thank you so much for your responses. I was wondering about respite care but not sure how to go about arranging this, or whether it's something the hospital will do. DH says they've put her in a side room in A&E overnight as they don't have a bed on a ward available. So I'm sure they will be trying to get her out tomorrow if she doesn't require any treatment.

You need to make it clear that you can’t care for her and need a care plan of some sort in place.

DH’s Nan was set home once with no care plan in place to MIL and her sibling’s surprise, as she needed a lot of care for a few weeks. Turned out Nan had told the hospital she didn’t need carers as her adult children could look after her. They were all in employment, it was a nightmare and very stressful.

Next time she was in hospital her eldest son went in whilst they were discussing her discharge and told them she needed carers as they couldn’t do it. Nan was initially upset but actually got used to having carers.

The hospital can and should arrange respite - it isn't something you should arrange. She will need assessing by the mdt/social/discharge team (different names depending on the hospital!) and they will go from there to find somewhere suitable for her!

As she lives with you, they will bery pikely try and take the easy way out and put her care needs onto you.

This is where tour husband needs to be firm, and say that you or him cannot care for her, it is not safe for her to be discharged home. He needs to stay strong in saying that, and consistent.

None of that "I suppose we could try/see how we get on/may be able to manage"...

It seems heartless but it really isnt

Im going to be blunt, because many people dont talk about the reality of medical situations in the very elderly.

Your MIL is likely to not heal properly as pelvic fractures are difficult enough, but at her age, her low bone density and slow healing rate will significantly slow down her bodies ability to recover to allow her a quality of life that is not substantially impaired with daily pain and lack of mobility. In short, She is likely to be in substantial pain for a long time with little chance of being able to walk any distance again.

Have you and DH talked with her about her wishes should she be incapacitated? Do you know whether she would want to receive all treatment possible to extend her life, no matter the quality of her life? If you havent had those conversations, I would urge you to do so very soon. She will need proper nursing care and rehabilitation specialists to help her for at least the next 6 weeks if she is going to stand any chance of recovering any independence.. would she rather come home and be with you while rolling the dice on complications setting in, or go into a nursing home to fight for every moment she can?

Sorry I cant give you any more upbeat information, google pelvic fractures in octogenarians and pain index. I hope you can find a route through that you can all become comfortable with.

She needs to be assessed by OT and physio before discharge. That should happen regardless of who would or wouldn't be at home to help. The OT can arrange for any necessary equipment to make getting in and out of bed etc easier, and ask social work to assess for intermediate care either residential or at home, including carers. Just because her medical treatment is classed as conservative management so no surgery, they cannot tell you or her she can go home without therapies assessing her. Request urgent therapy review ASAP and don't consent to discharge without it.

I have seen plenty of very elderly people recover their ability to walk after a fractured public rami. I facilitate this every day. We cannot say how recovery will go without knowing everything else about her and doing a full assessment. Yes, people should know worst case scenarios, but they should also be encouraged to pursue rehabilitation.

Review by pain team could also help.

Trouble is her mobility was very poor before today. She has broken both hips over the years. The most recent one was a couple of years ago and post op she refused to do anything to regain her mobility. Until today she could only walk a few yards very slowly and awkwardly with the use of a walker. But her annexe is well set up for her - all on one level, toilet close to bed etc. She fell over 10 days ago too so is obviously getting less steady on her feet.

It's not really possible to have a meaningful conversation with her I'm afraid. If it's a tricky subject she gets angry or tearful. She clearly has some memory loss, gets confused and finds it difficult to follow a discussion (though DH says she did okay on the cognitive tests they gave her this evening). She actually has 2 pelvic fractures and DH says she is starting to realise that they won't let her go home until she can manage the toilet. So she is very angry with him as most of her problems seem to be his fault. 🙄. He's been in hospital with her for hours poor soul and has only just got home.

I feel so very sorry for her. She has terrible social and health anxiety so this will be a nightmare for her. She will also only eat a very small range of food and is likely to refuse anything not to her taste (which I expect will be most things).

I really do appreciate all your advice.

Let's see what tomorrow brings. Am hoping my sleeping tablet kicks in soon!

Bloody awful for you
All my love xxx

My mum is not as old as your MiL (she is 85) but we lived in a similar situation with a granny annex. After being admitted to hospital after a fall it was her inability to get herself from the bed to the toilet and back and our refusal to assist through the night that triggered her move into a care home. Before everyone thinks that I am a total b!tch - I had cared for her singlehanded for 8 years, not going away unless there was a Grandma sitter and in the end not leaving the house or having a phone call for longer than 45 mins/an hour because she needed me. The original intention was that she would have four care visits and while they put that in place she went into a rehab facility but the staff there helped me see that caring for her in her granny annex was not going to be an option and they recommended 24 hour care. The decision was taken out of my hands for which I will be forever grateful.

@IthinkIsawahairbrushbackthere - totally understand. MIL is the last surviving parent for DH and me. The other 3 all suffered a terrible drawn out end of life (cancer and dementia). My mum spent her last 2 years in a care home with dementia and unable to walk. There's absolutely no way dsis or I could have looked after her at home. Even very slight, frail elderly people are still difficult to lift and manoeuvre without hurting yourself or them.

My knee has not recovered since mum came home from hospital three years ago and it took two of us 45 minutes to put her in the car.

Well thankfully they've said she can't go home until she can manage the toilet herself. Though DH says she's not co-operating with the physios, so I don't know how long that might be 🤷‍♀️

A member of our family fractured their pelvis last week around them Same age as your mil. They are not being allowed home for weeks they have said.

My knee has not recovered since mum came home from hospital three years ago and it took two of us 45 minutes to put her in the car.

This is what worries me. I have borderline osteoporosis, painful knees, back issues etc. Much as I might think I'm not going to wreck my body for someone else (especially someone who has refused to make any effort to maintain their mobility, or eat properly to avoid any light-headed episodes ), when they're flat out on the floor in front of you what are you going to do? 🤷‍♀️

Can you ask to speak to the physios or OT to express your concerns, or can DH? Might help them better understand the fuller picture. Sometimes patients will accept home truths from "white coats" rather than family (not always tho of course!). I'm surprised and disappointed if therapies have not picked up the phone to you yet, it's one of the first things I'd think about doing (obviously taking consent, capacity, best interests etc into account). Have you considered or already got things like falls pendants etc?

@Tront - yes she has a pendant. It was on her bedside table so when she got out of bed to go to the bathroom and fell she couldn't reach it (or the phone by her bed). Her annexe is only a few steps away and we walk past her window/look in multiple times a day as we're always out and about with the dogs and gardening. But she gets up late if she hasn't slept well so when we didn't see her sitting in her armchair we assumed she was having a lie in.

Physios had already been when DH went in today and I don't think he got much info from the ward staff. Maybe we'll find out more tomorrow.

We've just had similar with my grandma but she lives on her own.

My info is third hand from my aunt, so I may not get the terminology correct but this is what happened.

The hospital should do a needs assessment before she goes home. They then discharge with a temporary care package in place. My grandma had Personal Care, allocated up to 6 weeks. Carers to come in 4 times a day to help with medication, shower, dressing, toilet.

Once home grandma got a visit from the care manager to make sure her needs where being met (she lasted a week and then refused to engage with them.... But that's another story about a fiercely independent woman who is incredibly stubborn!)

Whilst recovering from a fall there is a higher risk of falling again. It is therfore in everyone's best interest to look after her.

As you have issues with helping with self care, she is at risk. Don't be railroaded into offering help (even if you do actually do it, which is understandable) the assessment needs to be done as a worst-case scenario perspective (ie you're at risk because of osteoporosis, husband's arm is unable to take the strain).

You need to speak to the Occupational Therapist, ask the ward manager for the contact info or to make you an appointment whilst they visit your mum.

Every hospital and local authority work differently, but this was our experience of Winchester Hants.