DM having hip replacement after fall-worried sick

[OnthePiste]

Hi DM, 89 with middle stage Alzheimers fell in her Care home yesterday and has fractured the top of her femur. Hospital called today to say they want to operate to do a partial hip replacement. The alternative is to leave it to heal which would take weeks of her being in pain so I agreed to the op.

The consultant then called me back to tell me a very long list of risk factors for someone of my mum's age, especially with her other health conditions. He said she may not survive the op, never walk again, her cognitive ability may rapidly decline and there is a 1 in 3 chance she will still be alive next month. I don't really understand this probability, can anyone explain please?

They are either operating today or in the morning, understandably they are very busy today. I am so worried that I either won't see her again or her life just won't be worth living. So upsetting just before Christmas, she was going to come to us for Christmas lunch and I really was thinking this would probably be the last time she would be capable. Has anyone been through similar?

My aunt had a fall at age of 87 that meant an emergency hip replacement. She recovered very well, but had no other health issues or dementia.
My father, 88, needed a hip replacement but he refused and he has now been bedridden for over 18 months. He can only lie on his back because of pain, so is on air mattress and in a nursing home.
I was aware of the 1 in 3 statistic, think it is because of post op risks, infections etc.

My mum did similar, and had the op. She's walking beautifully now, though with a frame. (healed very quickly!) She has capacity so made the decision herself and we were just informed. She has no memory of any of it though, and came up with a detailed but impossible explanation as to how and where she fell (in her home)
For a few days after the op she was full of all the drugs and seemed terribly confused but that did settle down. She's still managing alone at home (with some support) She does seem smaller and frailer though, whereas before she seemed invincible. I'm seeing early signs of dementia I think (siblings agree) and that does seem to have accelerated a little if I'm honest (op was in July) I scared myself by googling the statistics after the partial replacement in elderly people. So far she's doing better than I expected. She's a little younger than your mum but not much.

However she's not feeling pain from it, which is very comforting.
Very best wishes to you and your mum

My DM fell (aged 85) and had the same op. Risk factor was also quite high as she had other health issues including heart failure. I remember the consultant also saying they had the option to not operate and just let it heal but they went ahead and did surgery. I assume DM made her own decision as she had full capacity. She survived the op without complications but the healing and rehab process was long and slow (DM not the most positive or determined of people). She returned home 3 months later and was able to manage on her own with daily care visits. I remember the consultant telling me that at DMs age, mobility was usually reduced by one level even after surgery - so able to walk unaided previously meant using a zimmer frame after the fall/op, using a zimmer before the fall/op meant using a wheelchair afterwards.

DM lived for a further 2 1/4 years after her hip op.

Hope she can make a good recovery. I imagine she is very vulnerable unfortunately. With older people the anaesthetic itself is a risk, the subsequent immobility can increase risk of infections like pneumonia and the mental capacity may limit ability to regain mobility through physio etc and potential fall risk by being unable to recognise their limitations.

Thank you for these positive stories, they are very good to hear!

My dad fell a few days before Xmas last year. He spent ten weeks in hospital as one thing after another went wrong after his hip op. It was a tough time but he's scooting around on his frame these days so have hope! All the best to your mum.

I would always take the risk. I had to have a hip replacement in my early 50s (mid 50s now) and it transformed my life to be pain free again.

It is high risk for your mum but a life in pain is no life.

OP "there is a 1 in 3 chance she will still be alive next month"

are you sure you have that right?

I would go for whatever is less painful but I appreciate it's a tough call.

Would they give her the option of epidural rather than general? Lower risk. My mum broke her hip two years ago, had it replaced with epidural (comes with sound effects, apparently ), recovered well, but then Covid and lack of physio etc, but she is 2 years older now. She never went back upstairs but is still living at home (carers x 2/day plus I visit every 2-3 weeks and organise all,food/bills/laundry...from Dublin..she's in London).

I am so sorry about your DM.

My mum fractured both her hips at different times in her late 80s.

She had multiple risk factors for surgery but not having it could equally have lead to all sorts of problems that come with immobility for a long period.

Both times she was out of hospital in less than 2 weeks and managing at home.

I was fortunate that I didn't have to decide for her and there are no guarantees either way. If I had, I think that I would have said yes. For what it's worth, I don't think the hospital would contemplate surgery if they didn't feel it was a good option for your DM.

Sorry if this is a bit of a ramble but I really do feel for you; it's hard trying to make the right decision for a loved one.

It’s a high risk but there are high risks from not operating, all the things that go with prolonged immobility - pneumonia, bedsores, urinary infections, deep vein thrombosis, mental confusion and worsening of the Alzheimers, muscle wastage and future falls/immobility

Hello @OnthePiste Both my parents and my MIL have had surgery in their 80s and 90s including 3 hip replacements, triple heart bypass, emergency surgery when a goitre occluded their windpipe - we had to decide on that as they were on a ventilator - actually a really easy decision as you can’t stay on a ventilator - we just had a Conference call with the consultant and said go for it. They all survived all the surgeries and made good / fairly good recoveries. However, none of them had / have dementia.

In the case of the triple heart bypass the first surgeon said he would not operate due to the risk of death on the operating table; the professor then said she would operate and assessed the risk of death as 8%.

Have you asked the surgeon about his / her personal statistics? Remember to consider who they are operating on, e.g. the professor was taking patients other surgeons were refusing. If it was me I would rather die on the operating table than be in pain / immobile from leaving a fractured neck of femur , especially with Alzheimer’s, but of course everyone has their own view and I would aim to make the decision your mum would choose for herself.

I hope you have had a chance to see or speak to your mum today and I hope it goes well tomorrow.

It’s one of the commonest bony injuries in older folk and almost all patients do get surgery of some sort unless they are so unwell they’re unlikely to survive more than a few days for other reasons. A broken hip is incredibly painful and can’t be immobilised (like a broken wrist can for example) so it hurts with every movement and not operating is basically committing someone to several weeks of bed rest and pain, and a high chance of pressure sores, pneumonia, DVT’s.

we also used to advise people that there would likely be a one step deterioration in mobility after a broken hip - so someone who was mobile with a stick before would likely need a frame to walk after or someone who could only stand to transfer may need hoisting, etc.

Mortality is high after hip fractures and disappointing hasn’t improved much despite enormous amounts of work in the last couple of decades. It reflects partly the severity of the injury and partly that it is often precipitated by some sort of other medical problem/frailty. Dying in theatre is rare, but they do have to advise of the small risk. They wouldn't be proposing surgery if they thought that was likely to happen. There are calculators which help to predict individual mortality/morbidity and it sounds like the surgeon may have used one to help predict how things may go, but the number you’ve quoted doesn’t sound impossible. It’s worth mentioning that comparing hip fracture surgery with a planned hip replacement is like comparing apples and cows… they’re totally different!

getting the operation done ASAP is one of the most important things, hopefully with input from an orthogeriatrician as well as the surgeon and anaesthetist. The anaesthetic can be done either as GA or a spinal and there isn’t overwhelming evidence in favour of one over the other, but the anaesthetist may have strong feelings based on their assessment of your mum. There are some definite contraindications to spinal so if she has any of those GA would be the alternative. HTH (doi: have anaesthetised a lot of patients with hip fractures!)

My FIL had one earlier this year aged 90. It's healed beautifully and now uses his frame way more than his wheelchair.

My mum was older when she did exactly the same. Her operation was done with an epidural and she said it didn't hurt at all.

She was in hospital for 8 weeks and said some very strange things when she was in there - completely paranoid at times - but apparently that's very common. Look up delirium and elderly hip operations if you notice this.

When she first came home she had to have someone with her all the time. She could go to the bathroom on her own (mercifully) but couldn't get dressed. She had to use incontinence pads, but doesn't now (about five months on from her fall). It seems she didn't recognise her own home, which was upsetting at first.

The only problem we've found is that if we hadn't spent every night with her (big family) then she couldn't have managed that period of time after coming out of hospital. She had four carers a day for free who rushed in, washed her and ran out again. They would call every day saying "I'm running late and will be with you at midnight, is that OK? knowing full well we'd say don't bother. That really pissed me off, tbh. In the morning they'd turn up at any time between 6 am and 11 am. By then we had got her washed and dressed so they'd just go off again.

What was so annoying was that they used the fact they weren't needed to argue for care not being continued, but we had to be there because we couldn't rely on the carers.

I really hope your mum's operation goes well, but if I were you I'd be looking at care or convalescent homes just in case.

She had the op yesterday so I went to see her today. She recognised me but still pretty confused and not making much sense. She was coughing a fair bit and very weak. The ward have called this evening to say she went down hill after I left and they had 3 Worrying hours with ICU doctors coming to see her. She has pneumonia so is on intravenous anti b's. They can't do anything else as she's so frail but she's comfortable now. They will call me in the night if she goes down hill but I have to say this does not sound good at all. I really can't believe how quickly all this has happened

A lot depends on pre-existing conditions. My OH (very much younger than your Mum) had Parkinsons and fell and fractured his hip. He never fully recovered from the surgery and died nearly a year later, having been immobile and paranoid and deluded for the whole of that time. It is a significant injury in those with pre-existing pathology.

I am sorry that your Mum has this problem. Do not feel bad if she quietly slips away - life will be hard for her if she survives this. Life is bloody cruel sometimes.

Oh what a nightmare for you both
I'm glad she is comfortable.

all good wishes

I am sorry that your DM is so poorly.

It sounds like the hospital are doing all they can to help her and keep her comfortable so you can rest easy in that respect.

I hope things improve overnight for your DM and don't forget to look after yourself too.

On another note, my cousin Joan had a fall and later died - just a couple of weeks ago or so she passed away, no hip operation. She was 97.

Both my parents had hip replacements, they were in their 70s I think, no problem ever later in life with it. But right now, the pneumonia is the thing to look out for and I would visit it as often as you can.
See if you can get her to drink something so long as it's not a risk of aspiration pneumonia (stuff going down the wrong way, into lungs, then curtains really in many cases). Protein shakes are good in my experience but only if she's up to it.