Delirium after hip surgery

[Pinklady81]

We are all very worried about my grandmother who is 92 and fell and fractured her femur last week. Prior to this she was of sound mind, lived in her own flat and cooked and went shopping for herself. After surgery a few days after she has rapidly changed into a different lady she is hallucinating , not making sense, ringing relatives up and asking where they are and just general confusion. It's so upsetting and we are at a bit of a loss. She has had all the standard checks done eg bloods, urine and they have come back clear so leaning towards the trauma of the injury and delirium taking hold ? Has anyone got any advice as doctors don't seem too worried and just think she's a frail old lady with dementia when she was not before entering the hospital ..... many thanks for reading

This is very common and usually resolves with time. Sometimes it's just the op, sometime the pain killers we give and other things. It may help to politely but firmly explain that she is usually cognitively fine and this is out of character as you probably already have.

Suggest also asking has she seen an orthogeriatrician as ideally she should have done and they are expert in managing delirium like this.

Some information:
www.guidelines.co.uk/mental-health/sign-delirium-guideline/455222.article

İmportant thing is to let the staff at the ward know that this is not her norm. Delirium should be diagnosed and treated promptly.

They have withdrawn all medication since we noticed this , yesterday she was incontinent and today she was asleep with her eyes open and unresponsive for a while? Some parts of the day she can have conversations about things like you must remember to lay my rent as it's Friday tomorrow etc and others she has been saying she's run a marathon and won, she ca hear things and see things that aren't there and adamant family members are present when they are not . We are all so desperately worried but there doesn't seem to be anything happening and they don't treat with medication they said

Sound like they possibly think this is due to the medication then.
Often people with hip fractures are give morphine related pain killers which not uncommonly cause delirium like this but are needed due to the severe pain. It's obviously very distressing for you all but she probably needs time to get the drugs out of her system which can take a while.

My dad had this and it was very distressing. Sorry you are going through same.

My dad was like this after surgery. We were really worried, thinking that he’d had a stroke or something! After talking to his doctor, we were reassured that it’s very common after surgery on elderly patients. It lasted about a month.

We were told that there is sometimes dementia in the background but the operation brings it to the fore. I think that was the case with my dad.

My grandma had the same injury about 2 weeks ago. For the first week after her injury and surgery she was convinced she had been beaten up and had no idea what was going on but she has improved so much!

I hope she improves soon for you

Not quite answering your question here sorry but when someone has delirium it can be helpful to do as much as you can to keep them orientated while they are in hospital. So familiar blankets, pillowcases, family photos, a clock and calendar or whiteboard with date on and who the next visitor is and when in view, depending on what the ward's infection control policies are x

The medication she was on was apparently
codeine and a sleeping tablet which she takes anyway this has now been withdrawn for two days but no improvement at all ! There are no notes like in past times on the end of the bed so we are unsure what's going on medication wise and she has been sent for a CT scan but apparently they couldn't get a cannula into her and she is complaining the nurses have hurt her .

Jumping on your thread @Pinklady81 as my 82 yo mum has broken her femur and has developed delirium . She has diagnosed Alzheimer’s but has been living alone and managing shopping etc until the fall. This makes things even harder as it’s not as black and white as your grandmothers case. The delirium comes and goes but she failed the mental capacity test today. She really doesn’t want to go into a nursing home but we don’t know what the immediate future is

@Soontobe60
that is good to hear your dad got over it. Did he already have dementia?
my mum is improving a lot but I get the feeling she is so much better when we visit, then drifts off somewhere else again very quickly

This happens to my FIL every time he has a hospital stay. It's so strange but it's not dementia and doesn't last - he goes back to being completely normal a few days after going home. Staff are never very concerned but it's scary to witness.

It’s important to get documented on the notes that the current state is not normal for them. My father wasn’t taken seriously until I detailed a journey he had made a couple of days before hospital admission

I’m sorry. This happened to my father as well, who was normally absolutely fine cognitively then went like this overnight. He developed it during a bout of pneumonia. It was such a battle to get the doctors to understand he was normally fine. Sadly in his case he never recovered from it and stayed the same until he died around 6months later. It was so sad to see him like that. Maybe there is some dementia underlying the surface that trauma brings to the fore as a previous poster said. I’m so sorry you are going through this and hope she recovers.

Years ago I was hospitalised with a back problem. All my fellow patients were about 50 years older than me and were recovering from emergency hip operations. It was bedlam.

Most of them didn't know where they were and were shouting out all the time. One thought I was the nurse even though I couldn't get out of bed. I thought they must all have been suffering from dementia.

Over the next couple of weeks they all gradually went back to normal and were perfectly coherent. The nurses said that it takes a long time for old people to recover from the effects of the anaesthetic.

This happened to my grandmother. Fell and broke her hip at home. Previously living at home alone and of totally sound mind other than the usual 92 year old issues! After the operation she had delirium. She didn’t sleep and never stopped talking, drove the staff mad! She never recovered from it and passed away a couple of weeks later in hospital. It’s very common apparently. Fingers crossed for your grandmother.

I could have written your post. My DM who is 88 broke her neck of femur from a fall and had a hip replacement about 3 weeks ago. She was affected in exactly the same way and has gradually got better. It happened last year as well when she fractured her pelvis.
She has slowly improved but it is very worrying for a few days. A doctor did phone me to ask what she was like before so they were well aware of the situation. I think she has early stages of dementia anyway, but not diagnosed.
they stopped the really strong pain killers or switched them not sure. But it is the combination of the trauma, general anaesthetic and opiates.
however, last time she never got back to how she was before and although improved a lot now I also don’t see her cognition returning to the level it was.
returning to familiar surroundings is really helpful. You need to get her home as soon as medically possible

@lazymum99 thank you she is not capable of returning home at the moment physio hasn't been able to start due to the delirium this has been going on now since Sunday slurred speech and getting worse each day. The doctors have asked what she was like before and we have said she we was for a 92 year old remarkably well unsteady on her legs but not the way she is now it's like a different lady is there ! X

There is such a thing as 'anesthesia induced dementia'

www.alzheimers.org.uk/about-dementia/risk-factors-and-prevention/general-anaesthetics

Hopefully this will only be temporary.

My 87 year old mum had hip surgery. She has Alzheimer’s but when she came round she was completely gone she was in 1987 and as far as she was concerned in her bedroom. It was quite worrying but after a few days she got back to normal.

It’s unfortunately common in the elderly especially after a hip fracture. It’s a combination of the accident, the surgery, anaesthesia (doesn’t matter whether it’s a general or spinal both can cause it), painkillers, lack of sleep, being out of normal routine while in hospital. It can be a symptom of an underlying condition but more often is just be aid of the above factors. It’s not dangerous in itself but is incredibly frightening for the person experiencing it and distressing for the family. And as you have realised can delay recovery because they can’t access physio, don’t eat and drink properly, don’t get proper rest etc.

A PP gave some really good tips about managing it and it seems like the hospital are doing the right things by stopping medication that might cause it and considering a CT scan.

Sadly a hip fracture, even if it heals well and the delirium settles can need a very long recovery and often leaves people much frailer than they were before it happened.

Give it time OP.

This happened to my 85 year old dad after a hip fracture. It was scary and apparently due to the anaesthetic.

We got him out of hospital asap and stayed with him in his own home for a couple of weeks. In familiar surroundings after a week it resolved and he went back to his old self ( fully capable of managing his own affairs).

He did need three weeks of privately funded physio to regain mobility and now manages to walk reasonable distances without a stick or frame.

@SimmerInTheCity that's great news to hear at the minute they are moving her now from a private room into a ward with others so not sure how that will go down ! They have said she is a long way of discharge but on a plus side she had walked a few steps today but the physio said so very confused so I'm doubting they will let her out as she will fail any type of mental health assessments I'm sure

My mum failed the mental capacity test and the trust have a delirium pathway- they are sending her home for 72 hours with round the clock carers to see if she settles better at home. Lots of visitors is helping and I might go and stay a bit like @SimmerInTheCity suggested