Alzheimer's, broken hip and delirium

[loopylou459]

DM is 85 - has quite advanced Alzheimer's and lives in a care home. She could walk a little way unaided and quite well with a zimmer. She could eat and drink independently. Was incontinent though.

She had a fall on Sunday evening. Paramedics called and said just bruising. Was in a lot of pain the following day and eventually taken to hospital on the Tuesday afternoon, where it was found that she had, in fact, broken her hip. She eventually had a repair operation on Wednesday.

I've come to visit her today (I live a long way away) and am feeling pretty despondent about the future. She is looking extremely frail, not eating or drinking, refusing medication. Mainly sleeping but when awake not making any sense at all. They say it's delirium. She's refused to get out of bed for physio due to the pain.

Looking at her, I just can't see how she's ever going to recover even enough to go back to the care home.

Not really sure why I'm posting.

Is the carehome a nursing home? If so she should be able to return, if not it maybe she needs a nursing home. With support from district nursing and hospital at home they can provide most of what a hospital can.

It is still early days and things can change quite rapidly.

I know it is a shock when there is a sudden change like this.

I’m afraid to say your concerns are probably accurate. The statistics of recovering to baseline are very poor and it sounds like baseline was poor already. I imagine it will be a prolonged stay in hospital before discharge to either a good care home that can manage her or go into nursing.

No it's a care home not a nursing home unfortunately.

Sorry to hear about your DM. It’s still early days and while unfortunately this turn of events can lead to a swift decline, effective pain management and early mobility will be absolutely key in trying to help her rehabilitate. Try and keep her oriented - even simple things like reminding her that it’s day time, who you are and where she is and reassuring her. Ask the nursing team about her pain relief and any options for better pain management. Ask the physios if there are any ways to get her sitting out of bed even if this is via a hoist/into a suitable chair and ask them to give you some advice on maintaining her mobility while she’s in bed. Even simple things like encouraging her to move a little in the bed/take some big deep breaths can be helpful in maintaining some mobility and preventing a chest infection. Hope that’s of some help and wishing your DM well

You don't have to have a firm reason to post - sometimes just typing words out can help you clear your own thoughts.

The GA alone would have been a really strong knock out for your DM - so give it time and I mean a week or so, not just 48 hrs. A hip fracture is a big deal for a frail 85 year old so recovery will be slow.

As for pain relief - ask if they have considered patches - we got those for my DM and they did seem to help and certainly overcame the refusal to take liquid or tablets.

Ask the staff how they think she's doing and what timescales they are working to

Thanks - you are right I need to wait and see I guess. They have given her a patch but they said it would take 3 days to take full effect. Hoping she'll feel a little better when it kicks in.

They moved her with difficulty from bed to a chair today using a hoist and she was crying out in pain 😔

My mum had a bad fracture (no surgery though - pelvic) about a year ago and also had delirium - it's pretty par for the course in hospitals with the elderly. Seems to stem from UTis most of the time. They didn't seem to rush themselves testing my mother for it but that's what it turned out to be.

I also remember her crying out when lifted out of the bed but she gradually improved. It's early days yet. Stays in hospital can be quite lengthy. My mother was in a sub acute, rehab type ward for seven weeks. Unfortunately this raises the chance of further UTIs - it's not really possible to wash and toilet properly in a bed and the staff are always in a rush.

There has been some improvement in her mobility since and she is in a care home which has three tiers - residential, dementia needs, and nursing. There's been quite a decline and her appetite never really returned, this is usually managed with supplements. She doesn't require nursing care but help with personal care, showering etc. Hopefully the care home can accommodate your mum to return - things may change over the next couple of weeks.

Thanks - that's useful to hear.

There's been no improvement whatsoever today. Still not eating or drinking. Still refusing meds and not getting out of bed. Still delirious. I'm probably just expecting too much too soon. It's just so hard to see her so helpless.

I’d also ask the staff if the OT can see her and make any suggestions. We did this when DMIL had Dementia and Delirium and was in Hospital. They can put things in place which will hopefully orienate her a bit more. DMIL was convinced she was in a train station.

And do speak to the Discharge Clerk on Tuesday to see what the plans do far are.

The same thing happened to my mother after she’d been in a dementia care home (not nursing home) for about two years, she fell and broke her hip and had surgery.

In the hospital she wouldn’t eat and had to be prompted to drink. She refused to stand or cooperate with physio. She was on strong pain meds so that probably contributed to her confusion, along with being in an unfamiliar scary environment.

The care home manager visited after ten days, and asked them to discharge her back to the home, the hospital were happy to do so. She was returned on a stretcher in an ambulance. She used a wheelchair for a short time, but over the next four weeks the care home (along with a physio) rehabbed her back to baseline and she was fully mobile and eating again. She would cooperate in the care home because she knew the staff and they were able to deal with her in the right way.

If the care home is willing, and you have confidence in them, aim to get her out of hospital asap. Hospital is a very bad place for people with dementia and she is unlikely to improve while she’s there.

My uncle 84 died a few weeks after broken hip surgery. He was OK, quite sparky in the couple of days after, but then began to decline rapidly barely eating or drinking, delirious and eventually struggling to breathe. There was talk of moving him from hospital to a care home on NHS continuing care funding, but he was too poorly to move really. He would have died in the ambulance.

Wow that sounds like good and proactive care from the care home. Somehow I can't imagine DM's doing that. The manager hasn't been in touch to explain what happened or ask how she is. I had a voicemail from a carer at almost midnight on the day she fell and another call saying she was going to hospital - that's it. Definitely cannot imagine them going to visit her in hospital or proactively wanting her back. It's a great care home for those who are still with it - lots of activities and outing etc. I have the feeling the dementia /non-mobile residents sort of get forgotten about beyond the essential care if you know what I mean. I doubt they'll be rushing to have her back in her condition.

I'm so sorry to hear this. It feels like such a brutal way for life to end.

My DM has asthma and a bunch of other health problems so I don't think the odds are in her favour at the moment. My brother is going to see her today so I'm waiting to hear if there's any improvement today.

Elderly people are never really the same after a bad fall but some can surprise you by how they do recover, my mother was able to shuffle about with a zimmer, up the corridor, even a couple of little walks outside in the fresh air, within four weeks of hers, a broken pelvis at 88. Every case is different.

@loopylou459
That is so disappointing re the care home.

It is worth giving them a call and seeing what they say. The hospital is likely to be keen to discharge her soon so you need to know what your options are.

I would speak to the Manager of the home too.

It can take 6 months for a delirium to resolve and people often don't ever return to baseline

Think about what your mum would want if she could choose, have a chat with your family, and then decide on a ceiling of care with the medical team that sits comfortably with what your mum's wishes would be

My 80s DM had a broken hip and delirium at Christmas, she was living at home (with DF) and has some memory problems but the delirium was really shocking. However she was discharged home with a care package a week after surgery and did get back to her baseline physically and mentally after a couple of months - physically she was in very good shape beforehand, her memory is the issue although she isn’t diagnosed with dementia. Possibly different though was that she was determined to get moving again in fact that was hard too as we were terrified she’d fall again (I think she has ADHD, she is a very restless person). The delirium was full on for about a week after surgery and then gradually disappeared.

Exactly the same happened to my Dad before Easter. He's back at the nursing home, still a bit confused but much better. He was very sleepy for over a week I think. Much more alert now.

I saw old men on the ward who looked like ghouls after their ops. Completely loopy. Before you knew it they were standing and ready to go again.

I’m really sorry to hear this.

Breaking a hip at that age is a huge shock to the system. My MIL did this, and I’m sorry to say that her dementia just fell off a cliff after that - she forgot how to swallow, had to have thickened drinks, and that was the start of the end.

What do the nurses say about your mum not drinking or eating? Are they trying to persuade her? What do they plan to do about the delirium?

It is early days, so I hope your mum improves.

the care home sounds a bit shit too. Some more concern about your mum would be nice.

Take care of yourself.

Thank you. They have to feed her as she can't do it herself so I think they must be trying to encourage her at mealtimes. Not sure about between meals. But she just refuses or if they put it in her mouth she spits it out. Same with her meds.

As far as I know they don't have plan to do anything about the delirium....what sort of things could they do?

Yes the care home has been a bit of a let down.

I’m sorry, I don’t know what can be done about delirium but I’d ask the medical staff. ‘What happens if Mum keeps refusing food and especially drink? How long will delirium last? Is there anything you can do to improve it?’ and see what they say.

Unbelievably I've just had a call from the care home to say that the hospital has been in touch with them this morning to say that DM is medically fit for discharge! She's been in for 8 days and only had the operation last Wednesday.

She can't get out of bed in her own - she can only get out of bed using a hoist with three people to move her.

She's still not eating or drinking anything. Only getting fluid through a drip.

She has a catheter.

She’s delirious and doesn’t understand what’s going on.

I'm totally shocked and don't believe the care home will be able to cope with her as she currently is.

If they refuse to take her back what happens then?

That sounds terrible OP. And she's being discharged to her old care home? Or will there be a temporary NH placement?

I thought that safety was paramount - 'unsafe discharge' being the phrase they use. When my mum was discharged (after 8 weeks, not days!) she could not return to her assisted living place, and this was decided after discussion between the hospital, SW and the AL manager. If the care home cannot take her it will have to be a nursing home presumably?

Sorry - just edited to say that I hadn't read that the care home contacted you. It all seems a bit odd, care homes are not set up to deal with that level of assistance. Does she have a social worker?