Where do we go from here?

[GnomeDePlume]

Up until 4 weeks ago DM(85) was doing fine. Lived alone in a bungalow with family member close by calling in regularly (most days) for general chit chat.

Then she took a fall and broke her leg requiring surgery.

In these 4 weeks DM has declined so much. Her short-term memory is shot. She has stopped eating, she still chooses food but then just pushes it around a bit without managing more than a mouthful. She still drinks water but isn't interested in any other drink (she used to be a big tea drinker).

DM is now in a ward waiting for discharge to another hospital where she will do some physiotherapy.

It all seems too little, too late. She isn't getting out of bed. Her world has shrunk from bungalow, well tended garden, clubs, to the tray over her bed.

Is there any coming back?

I'm not sure what answers I'm looking for. It all feels a bit miserable at the moment.

Long hospital stays are crap. Its not unusual for elderly people to become confused and disoriented, they experience muscle wastage and lose their appetite because they are stuck in bed so much of the time, the original fall plus being infantanilsed means they lose confidence and can get pretty depressed.

Some people can bounce back from this - maybe not to where they were but certainly to a much better quality of life. But there are no guarantees I’m afraid. What do you think he chances are of moving her to rehab or her being able to manage at home with carers?

I’ve heard of this happening a lot. It seems to be incredibly common. I’m sorry I don’t have any advice, but gentle encouragement and finding things to interest her may help her regain her zest for life.

The hospital she is in have been talking of moving her to a rehab unit. We are in quite a big county with small specialist units scattered all over the place.

The ward she is in now (this is her third ward) is supposed to be a kind of holding place while next steps are determined.

We (her DCs) are concerned that essentially nothing is happening. Mum has become disinterested: in food, in moving, in getting out of hospital.

There have been some attempts at getting her to stand but these have been very painful and largely unsuccessful. I met the main physio. Probably great at jollying injured footballers along but I felt lacked the gentleness/kindness an 85 year old needs.

At some point does the hospital say they have done what they can and wash their hands of her?

My mil broke her leg in 2 parts she went into hospital was given room if her own. From there she went to a cottage hospital for physio for about 6 weeks.
when she came home to her apartment she was never the same, she always used to go down into the lounge and would be the chatty woman she was. This all stopped, she’d tell us she’d been but hadn’t we found out. She was supposed to walk more for her leg, she just sat in her chair. She’d tell us she’d walked down the corridor but hadn’t. Even the house manager spoke to her daughter to say she had not been joining in .
None of us no why she changed it just all seemed to happen after she broke her leg and the long hospital stay.

Well hopefully she gets into a rehab ward where they will be better able to help and also kinder.

you will hear all sorts of stories but you just don’t know. A place with more care can make a big difference. I wish her the best and I hope you’re holding up as well as possible 💐

Have the team mentioned possible delirium? Have they tried helping ger to eat - not forcing it in but eg load the spoon and just support it to her mouth? Have they assessed her mood?

The rehab stay is a good idea, I hope things pick up at least to some extent?

@GnomeDePlume sorry to hear about your Mum. Is it a rehab place or a reablement centre? The reablement facility our father went into was really good - although not appropriate for him longer term. The plus side was there was a mix of people - a recovering alcoholic who had been in hospital having been in a fight was brilliant with Dad. They made a comical pairing. There were people recovering from surgery etc. What the place did I still in us was the understanding of ‘baselines’. Essentially what the new place Dad was at to look to the future. For you that might be is Mum going to be able to get out of bed and start trying some new things. It was a busy place with chair activities for those with mobility issues, a gym type area with supervision for those wanting it. Mealtime was a communal affair. If she gets something like this little things may fall into place if she can gain some confidence.

@Mancity08 much sympathy for your DMIL. It does feel that the sudden shock of the fall, surgery, strong drugs etc can knock a person completely off track.

@EmeraldRoulette thank you. I think it is hardest for my eldest DB. He is visiting DM every day, encouraging, talking to staff etc.

The problem is that nobody seems to know anything. But this is typical for this particular hospital. It has been at the centre of multiple issues.

@PermanentTemporary it is strange about the not eating. The hospital food is very plain. DB and I have both taken in bits and pieces as mum has expressed interest but those are all sitting untouched. DM 'makes the right noises' but when it comes to it she is not actually eating. She just doesn't want to eat.

@BlueLegume TBH we just don't know where DM will be sent to next. Though it sounds like your DF got a lot out of the facility he went to.

The care DM is receiving is fine on the whole. Though I was quite shocked that on one day when DM was very distressed (insisting she was going home that day, complaining she had been made to sleep in a concrete tunnel) the staff just kind of looked at me. I suggested UTI. That didn't seem to have occurred to anyone. Antibiotics prescribed and she was fine again.

When MIL was refusing food after she broke her leg and subsequent surgery, we found it was because she was terribly constipated - partly because she was dehydrated and partly because she wasn't coping with the lack of privacy. She also had no appetite because she simply wasn't burning calories. Once she was up and moving independently, she picked up no end.

Am in similar position with my df. It's very sad. He's been in rehab but was stubborn about the exercises. Will see how he fares at home with help.
Depression is a big issue as well.
Getting old sucks!

My mother broke her hip when she was 84. She already had dementia and was in a care home. She was in hospital 10 days and would not cooperate with the physios, they told me she was immobile and incontinent, and refused to eat and drink. None of those things was true, she just needed prompting and the right type of help.

The care home manager ensured she returned to the care home asap - which was 10 days. Within a fortnight she was mobile and eating, after a month she was back to her old self and you wouldn't have known she'd had a fall.

The environment is really important and hospital is absolutely the worst place for elderly people to recover. Does your mother have the funds to pay privately paid for rehab? She shouldn't have to, but it may be the best option. The longer she lingers in hospital with no one doing anything, the more she will decline.

Can the visitor take in something to share, so they and your Mum are eating at the same time....? Then they can chat about how good it tastes, maybe a bit salty... etc... If she is expected to eat while visitors sit and look at her , she might find it a bit embarrassing.
Hospital food is rarely appetising!

Keep pushing for updates.... have to fight for everything/anything these days!

@GnomeDePlume I could have written your post a few weeks back. Mine has made it to the rehab unit. They say they keep them for 2-6 weeks,sometimes longer, and the physio and occupational therapists are really very involved. It's much nicer than hospital.
We're not sure if my mother will be able to come home. I mean she could, but she'll need a lot of extra care. 4 visits a day are provided for six weeks, for free, but they don't cover overnights. This is from a local community rehabilitation service. After that she'll need to self fund carers, and it'll also depend on how much care we can offer as a family.

I really feel for you. It's tough ( easier as mine can fund care or we'd probably have a funding battle) and our mothers sound very similar. The OTs have been very useful in helping us with things mum needs to help her poor muddled brain settle a bit. Photos and pictures talk about, which give the staff an 'in' for conversation starters.

The hospital food wasn't to my mother's liking ( she's always eaten very fresh food) and she's appreciated fruit and her preferred yogurts etc when I visit.

Best wishes to you both 💐

Ps my mother was in a kind of holding ward too, and they did their best while waiting for the rehab bed to be available. I think she did 6 wards in total,in 4 weeks. The OT has chatted with both of us about how that is enough to discombobulate anyone, and they are working on re-orienting her.

Also I second @Bonbon21 to suggest eating with mum might be helpful. I took in two favourite mugs recently so we could have tea together like we used to at home ( the housekeeper provided the tea as the trollley is available all the time at this place)

Sounds like my DGM, she was supposed to go to a place for therapy but they just sent her home instead. The OT comes to her house for the therapy. She's a lot older too but has always lived independently so struggling with being stuck in bed. She's doing well with the therapy but hating being stuck in bed but she's so tiny and frail not sure if she will improve any.

Literally just been through this with my mother. Slightly different as she has advanced dementia. Mum was very active, she walked miles around the care home with a wheely walker thing, every day. A bad fall, broken hip then a month on a ward. She had to be fed and encouraged to drink. There was some physio but not much. Then a month is a 'discharge unit' where people were safe warm and fed but bog all else.
So now she can't walk, or do anything much.
Fortunately a transfer to a nursing home has transformed her life. She is up and dressed and eating by herself and is obviously in a better place.

@PiddleOfPuppies DM was constipated for a while for similar reasons. Also not helped by significant amounts of pain relief. That side of things seems to be sorted now. DM is drinking plenty of water but still no progress on food.

DM is very down about her situation. She wants to go home but she still needs care as getting mum out of bed needs two people.

No movement on the 'next steps' front. Waiting for a space in a rehab unit. Like @Sharptonguedwoman describes, being kept warm and safe but damn all else.

I am expecting that DM will be self funding for care. DB and I have done a review of DMs finances. She has a modest pension, some savings and owns 2/3 of the bungalow she lives in (DB owns the other 1/3). Fortunately LPAs are in place and DB has been looking after her finances for several years.

My worry for DM going home is how vulnerable she will be. She is very independent minded and would always attempt something before asking for help. This has resulted in falls. I'm also worried she would be vulnerable to someone coming to the door and frightening her to hand over money.

In many ways it was easier with DMIL when DFIL died. DMIL clearly had advanced dementia. She was immediately admitted to a respite care home then to her permanent care home.

DB and I have agreed that DM cannot come to live with either of us. Neither of our homes is suitable and, quite frankly, neither of us want this. We are not a close family - middle class dysfunction. We are polite to each other rather than warm. In fact DB and I have communicated more over the last 4 weeks than we had over the previous 25 years.

We will do right by DM. There will be no stinting to preserve an inheritance (DM's estate is left to DGC who don't know this and are all adults making their own way).

Thank you for all your thoughts and good wishes. It is good to be able to hear other people's experiences.

Just popping in to this thread to wish you all the best (and your DB) - often it takes this kind of incident to realise how fragile the "ecosystem" is around independence for elderly relatives, and once that ecosystem is interrupted eg by a fall or illness, how it seems almost impossible to regain.

On the eating front, now is the time to lose any concept of healthy eating, at least in the short term. I found an open box of chocolates, fancy biscuits, even small petit four sized cakes all encouraged my DM to eat (and eating triggers an insulin response which can lead to increased hunger). And sharing food with visitors can help too, the social cues are important.

Oh, and another idea - if she will need carers and is self-funding, it may be worth engaging a carer to visit and have a chat/cup of tea with her now, maybe a couple of short visits per week. Then they become a familiar face and it can make the transition easier - for my DM having the carer pop in (oh, I'll just make you a sandwich while I'm here...) rather than the first time they see them is for the official care visits really helped.

@Defiantlynot41 thank you for the suggestions. Unfortunately even treat food isn't tempting DM. Both opened and unopened. It seems like all interest in food is gone.

Good thought about introducing a carer before starting actual care. I will talk about it with DB and keep it in our back pocket for when discharge comes onto the horizon.

I don't know if this is typical of long hospital stays, DM has been saying things which are definitely not true. She said she had had to sleep on the floor and that she had been home a week ago but DB had told her she had to go back to hospital.

It is possible these are just very clear dreams but it is worrying that when she is awake she still believes them.

Still no movement, still no eating.

Sadly, I think this is fairly normal with elderly patients 😔 My mother solemnly told the hca that she was finding the children riding their tricycles up and down the ward quite disturbing ( I was there - not a child in sight) Ive also wondered if she's remembering dreams.

The thing I have found quite disturbing is that mother can sound quite lucid some of the time and answer yes or no questions correctly and without difficulty, so she is considered to have mental capacity. She knows her date of birth and other long term memories ( her family's birthday's for example) but can't tell you what month/year it is.

This was much worse when she was still in the hospital. In rehab, the occupational therapists challenge her mentally a bit more, so her clever methods of covering up her confusion don't work the same way. Having established this, they are helping her sort of re -engage her brain through pictures and patterns ( she isn't diagnosed with dementia at this stage so there is still hope for improvement apparently)

We've also been told that some of her medications could be responsible for it. Painkillers like tramadol can certainly cause hallucinations. Are the team aware that she's not normally like this? After speaking to one of the nurses it seems that they are so used to it that it seems normal to them. They were surprised to hear that she was mobile and cooking her own meals before this hospital admission.

Is your mum drinking enough? We really have to push fluids with mine. I hope you get a rehab bed soon as they do seem to have a more proactive attitude toward recover there. Honestly though, I'm doubting whether my mother will ever be how she used to be.

Sympathy and solidarity to you 💐

My mum had a worrying hospital stay where she lost her lucidity due to a UTI and was then moved to a care home for reablement, and eventually home. It was being at home that really helped but she wouldn't have been in a position to go home without the care home stay. She did then recover and lived independently for several more years so don't lose hope of this.

I would say the best thing to be done for your mum right now is a move to somewhere with better care. Keep asking about this, politely but persistently. Find out what the options are and make appointments to speak to doctors and ward managers.

Can you get them to bring some Ensure type meal replacement drinks for her? You may need to push her to drink them but it's worth it if it breaks the cycle of not wanting to eat or drink. Sadly you are in the parenting role now and will need to get her to do what's good for her as best you can.

@WinterFrog that sounds very similar to my DM.

@Holesintheground DM is drinking water and at a reasonable amount during visits. It is just the whole food thing which is a problem.

On the plus side DM is being moved to the rehab place today. DB found out an hour before the scheduled move.

We found out similarly last minute, @GnomeDePlume
Wishing both our mums all the best!
I wonder if we could come up with a secret signal, just in case there is a new lady in mum's bay when I next visit...
( We're dahn saf, feel free to pm if you are as well!)