Dementia and Broken Hip

[WhereAreMyAirpods]

Dad has had dementia for around 5 years now and has deteriorated fairly rapidly over the last 18 months or so. Had a call from mum late yesterday afternoon, he'd had a fall, couldn't get up. Ambulance was called (and arrived quickly), DH and I dropped everything and jumped in the car - we are 2 hours away. Long story short is that Dad has broken his hip and needs an operation today.

Surgeon was careful to stress the risks of such a major operation in a man who is weeks from his 79th birthday. Mum wasn't really taking that in. I got the impression that they are expecting Dad to be in for weeks. He was very confused in the hospital, did recognise me when I arrived but was extremely agitated, shouty.

Not really sure what I am asking here. Anyone else had a parent go through similar? I'm not sure he'll ever be well enough to return home to be honest, the mobility issues coupled with the dementia might be just too much for my mum.

I'm so sorry this has happened.

It's a tricky one. The op to fix it could make him deletions and accelerate the dementing process however if treated conservatively the pain and meds can do the same.

Where I am they have scrapped hip precautions which was always the trickiest part of rehabbing someone with a cognitive impairment post surgery.

I think the consultant will have explained the mortality rate to you but I suspect the alternative is fairly similar in terms of qol.

I hope your mum and dad are doing ok.

I'm just packing a bag to go back for a few nights. Mum is capable and does not have cognitive issues but she is equally elderly.

There is no "good" outcome here. Dementia is such an awful condition. And selfishly, I am struggling myself at the moment with a horrendous menopause, anxiety, insomnia...

I'm sorry this has happened to your dad. I have experience of working with people with dementia and following fractured hips. My own grandma had dementia and they delayed the surgery for her btoken hip in the hope she would stabilise a bit more prior to anaesthetic but unfortunately she didn't but she was 93 so a fair bit older.

Unfortunately the stats about recovery post hip fracture aren't great but that's usually because of people's other health problems and previous mobility levels. 79 isn't that old, and although sometimes the dementia can deteriorate because of hospital stay, being out of a familiar environment etc, sometimes people do well because they can't remember they're not supposed to be able to walk.

Once he has had the surgery they usually try to get them on their feet quite quickly. Depending on how he does they might just rehab him at the hospital or move him to a specialist unit or care home. This probably will be a few weeks. It might be that he needs some formal carers to return home, or that a care home is an option. The hospital social Work team should guide you through that.

But right now I would focus on supporting your parents through the operation and seeing how things go. Your dad was probably in a lot of pain and because of his dementia struggling to manage/articulate this so that's why he was agitated. Take him in some familiar things - pjs, clothes, blanket, usual razor, aftershave etc to try and reduce the confusion of the hospital environment.

Thank you@Wrongsideofpennines . Mum seems to think he'll be home by the weekend. 🙄Some management of expectations needed I think. He is in the regional major hospital close to home and the surgeon we spoke to last night said that he would probably stay there for his rehab.

Spoke at length to my brother last night, we had both been speaking over the previous few weeks about getting social services in to assess Dad and to look at options for giving mum a bit of respite. This admission is certainly going to force the issue which is not a bad thing. We need to think about Mum's mental health and quality of life too.

Be kind to yourself. Allow yourself to feel shit without feeling guilty and make sure you try what you need to to keep yourself well. Protect the carers.

Post op and post rehab he will have PT/OT and they will assist you in discharge planing to the correct discharge destination with the right support.

Sorry that reads wrong. He will have PT/OT for rehab then they will do discharge planning.

(Very burnt out AHP who can't articulate on a day off)

Sorry to hear about your dad. And I agree with you about there being no 'good' outcome.

My mother has dementia and had a fall and broke her hip when she was 84 (this was four years ago). I was given dire warnings about it worsening her dementia and being the end of her, but actually she recovered back to her baseline within 5 weeks. She was in hospital for ten days.

But the critical factor was that she was in a very good care home when she had the fall, and that is where she was discharged to. They rehabbed her really well. If she'd been at home it would have been a different story.

As you say, the hospital environment is the worst place for someone with dementia, so getting him out of there asap is a priority, my mother was reluctant to even drink or eat in hospital, and they were leaving her with continence pads to save the bother of taking her to the toilet - she was entirely continent at the time.

I would look into the possibility of getting him discharged into a care home even if only for a few weeks to get him rehabbed. They will have all the equipment and staff to achieve the best outcome. If they have the funds to do this they can pay themselves, if not they will have to rely on Social Services.

I've just been through similar with my DFIL.

And my own father has cognitive issues as well as a severe disability and has just spent 10 days in hospital with Covid.

It is a particularly worrying when anyone elderly, especially with Dementia or cognitive issues, to spend a while in hospital as they are prone to delirium in hospital.
So if you can do everything you can to counter that. In an ideal world, if one of you can be with him as much as possible whilst he's in hospital that would have the biggest impact on possible delirium and many other benefits obviously, but it's unlikely unless you are lucky and they are happy to put him in a side room (where visiting hours are MUCH more 'flexible'). If you can find the Matron In Charge of whichever ward he ends up in straight after the surgery and tug at her heart strings, explain his dementia etc, she might be able to make a side room happen.
Either way, ways to combat delirium are to orientate him as much as possible. So bring him a clock, a calendar, familair things, pillow/case that smells of home, famil photographs etc.
Does he have a phone? Is he able to use it & communicate via a phone?
My Dad can't as he's blind so it was a huge part of why we were allowed to stay with him.
If your Dad can, that's great, you can orient him regularly via the phone.

He will also most likely have a catherter, keep a close eye for any sign of UTI in hospital and when he comes home.

The second challenge is when he comes home.
Firstly the OT (occupational therapist) will want to come to your home and advise you on changes you need to make to make it possible.
If they have a house with different floors.. you'll want to start thinking about how you can make it possible for him to live on only one floor, as stairs will probably be out for a while.
This might mean, making a bedroom downstairs, getting a commode, putting grab rails and ramps around. I would start thinking about this now. The sooner you have things prepared, the sooner he can come home, if that's what you all want.

The other ongoing challenge once home is thaf My DFIL would forget about their new disability and try to get up all the time. Risking another fall (which did happen and put him back in hospital). So it became clear he required 24 hours 'eyes
On'.

This is pbviously completely exhausting for the entire family, esp equally elderly DMIL, so it soon became clear a full time carer was needed.

Sorry to bombard you but this is all fresh in my memory, and I was given lots of this advice/experience and it was really helpful at the time.
Your DF is 10 years younger than my DFIL so I'm sure the process & recovery will be simpler. It's so hard as you want them home as you know it's better for them on so many levels, especially if they have dementia, but equally, they will need a lot of care in the recovery process so if he goes to a specialist unit to recover, it will be easier on you as a family whilst you get things as organised at home as possible and it doesnt break you all.

I wish you all the best, and hope the surgery is successful.

With decent and REGULAR physio, he will he back on his feet. But do push for the physio as every day of it counts.

Sorry OP, this is horrible for you all. My DM had dementia and a broken hip and my Dad thought that a few home alterations would mean she would be home. The reality was that the hospital discharged her straight to a care home as the dementia meant she couldn’t engage with the physio required. After the six weeks funded by the NHS we transferred her to a care home of our choice.

Sorry to be harsh, but I am afraid that you should start looking into options for care homes and how you are going to fund this as short of a miracle that is the most likely outcome for your DF.

Depending on your DM’s health, attitude and your finances, you may be able to find a set up for them both called ‘close care’. This is what we did for my parents. It’s basically sheltered ‘independent living’ apartments for the healthier parent but with a care home on the same site for the parent who needs it. If you use carehome.co.uk you can search on this criteria.

He is very lucky in that the hospital he is in is brand new and all single rooms rather than on a open ward. He couldn't use a phone but we spoke to the nurse yesterday about visiting which is open hours, mum could have stayed with him last night had she wanted but we encouraged her to go home to get some sleep. Their house is all on one level apart from a single step down into the kitchen.

Just want to add some more useful items you can consider getting for a return home:
Cameras / Baby Monitors
Bed sensor mat with alarm
Chair sensor mat with alarm

These were so helpful for us. Allowed us a bit more freedom to actually pop to the loo and make cups of tea etc.

@Whatevergetsyouthroughthenight I have no clue where to start with even looking at care. We are in Scotland and I think the rules are different about funding, but not sure. Parents own their own house and are both retired on civil service pensions. Comfortable but not money coming out of their ears.

This happened to one of my parents and it had two effects. Firstly the dementia accelerated quickly in hospital, especially in a private room where they became isolated. Secondly the hip never got full function back and therefore became largely wheelchair bound afterwards. They also forget they can’t walk so keep trying to and falling over. This has impact on toileting etc.

The main thing is to consider whether you’d want him at home or in a nursing home setting. With a mentally capable adult, either is doable in the short-term as long as she stays well. But it will mean a decent rota of carers and a lot of effort from you and your brother to arrange shopping, care needs etc.

I hope his op goes well and the recovery goes better than it did here.

That's all really good - take advantage of the private room and visit as much as possible without also breaking yourselves...
And brilliant that their home is one level. That will make things a lot simpler.

Hopefully the surgery happens within 48 hours of the fall as this has a big impact of recovery outcomes - push them if you need to.

Best of luck and don't hesitate to ask anything.

I must agree that a downside of a private room is isolation (if you can't be there a lot of the time) and also, primarily, the reality is that the hospital staff cannot be 'eyes on' all the time (same as in a care home fyi).

So whilst a private room allows you to visit as much as you like (which can have a huge impact on the delirium and therefore recovery outcomes) it does mean you need to be there yourselves as you can't rely on the nurses to 'watch' him 24/7 and your DF wont remember to use the call button...

yes there are advantages and disadvantages to it. Realistically, I can't be there 24/7 and neither can Mum. I can put my life on hold for a few days but I have to keep working and being there for my kids. Sounds awful to be selfish about it though.

Care is free in Scotland. It's task specific but if assessed to need care there's no payment even for under 65s under Franks law.
Im assuming he's in QUEH. The ahp team there are great. They will call you to discuss all of this.

That’s the reality of it @WhereAreMyAirpods and why planning for a plausible worst outcome is better than putting one’s head in the sand and hoping for the best. It’s a very hard time when you’ve kids, parents and a job to worry about.

Maybe this will all be better in Scotland but also do not accept discharge without a proper care plan in place. It was our experience that they saw an involved family and tried to pass the problem to us entirely to sort out. There is help but you have to be pretty straightforward to get it, e.g. Saying “I can come to visit once a week” or whatever the max you’re able to do is.

I've already had that discussion with my sibling. We both have friends who have gone through similar and they are quite clear - refuse to have him home without a proper care package. Brother is at the other end of the country, I am 2 hours away. We cannot be "carers".

I find that for a junior therapist that can be a difficult conversation as many families are trying to imply they can't be the carer but don't want to say it therefore they are trying so hard to say it without saying it and the young less experienced therapist doesn't always read between the lines 🤦🏼‍♀️

I'd always start my chat with a family saying I appreciate you have a life and a family etc therefore I don't expect you to do any of the caring but I don't want to step on your toes if you want to do it.

I think the team will appreciate your honesty if you tell them to assess your father as if he lived alone ie no one is able to tend to personal care etc. mum can presumably make meals but that's the limit of care family can provide for example.

Thanks @halfshutknife that's really helpful advice. Mum might want to be able to do the personal care but she doesn't have the strength for a start.

Maybe let your mum know that it's easier to cancel care than set it up.

I'd always take the maximum the hospital offer as they reassess via reablement in the community to establish if the care meets their needs.

If it is GGC locality they also offer 'intermediate care' which is a a bed in a care home but for assessment purposes it doesn't mean they are being admitted into a care home. They assess the patient like they are in their own home and try to establish if they are able to go home with maximum care package.

Other helpful pieces of technology are pendant alarm/falls detector and key safe

A lot of relatives are using Alexa to Alexa to do a checking in type thing.

My DM83 broke her hip last August. We had suspected that she might have the early stages of dementia before the fall. Whilst she was in hospital we definitely noticed a decline in her mental state and on a couple of occasions she became quite delirious, phoning me constantly through the night. This always happened when they gave her opioids for pain relief.

My DM left hospital and stayed with me for around 8 weeks. The NHS were fantastic in this regard as once the physio at the hospital decided she was fit to come home they arranged for a hospital bed, walking frames, high back chair, perching stools and toilet frame to be delivered to me. Carers would also come in once a day to wash her and I luckily had a very caring boss who let me pop home at lunchtime to make her lunch. We were also very lucky in that my DM lives next door to me so once she was more mobile we "visited" her house so she could reacquaint herself (she couldn't remember much about her house at this point which upset her). She walked around her house and you could see some recognition when she saw all her own things again.

We had to have a stairlift fitted as her only bathroom was upstairs. After about 8 weeks with us we moved her back into her own house and I stayed overnight with her for a few nights to check she was ok on her own overnight. We also got an emergency necklace for her with a fall monitor.

That was in October and she is now managing very well on her own and very happy to be back in her own home again. She does need a lot of support (she comes to me 4 or 5 times a week for her dinner as she only really heats food up now) and I have to do all her banking, make up her pill boxes and sort out all her appointments. I take her shopping with me and she uses a mobility scooter or a shopping walker. She doesn't have her full mobility back but enough that she is able to get around indoors pretty well with a walking frame. Her memory has stabilised although still not great and I suspect may get worse over time but she manages. Her house is clean and tidy and she still looks after herself very well.

Some of the stories from other Ops have been, understandably so, not as positive as our story and I know we were very lucky in that she lived so close to us which I know has helped her recover so much better but I still wanted to give you a more optimistic story to give you some hope.