Physio after broken hip

[OMFGSOB]

Mum is 78, very frail, has heart failure and dementia (such a cheery start to a thread 🙃)

About a month ago she fell and broke her hip. She's out of hospital now, with two carers coming 4 x day. She has improved a bit since the op, but can still only lie in bed or sit in a chair, and my dad is not supposed to move her when the carers aren't here.

She was having physio in hospital but apparently it will be several weeks until the community physios are able to come out, so she'll be pretty much completely immobile until then... My dad feels like they've given up on her 😔

To the question: would it be worth getting a private physio to fill in for the weeks before the NHS physio starts? Do private physios do this sort of thing? Or do they not like passing back and forth with NHS care?

Tbh I don't think she'll walk again, but even a small improvement in mobility would improve her life a lot!

Also, if anyone is able to suggest other forums for discussing elderly parent issues (maybe more active than Mumsnet?) I'd be very grateful!

How was her walking before she broke her hip?

Definitely get a private physio if she can afford one.

Until recently it was ok, but became much slower in the past 6 months (I think because of the heart issue). Just before she went into hospital she could walk around the house and down the road for about 50m (usually holding my dad's arm).

I’m assuming she had a hip replacement? If so, the physios will have given her exercises to continue at home. Ring the physio department at the hospital and ask. Four weeks after a hip replacement she should be mobile, but there are exercises she can do sitting and lying down.

When is her follow up appointment with the consultant/surgeon?

Did the physios from the hospital not give her any exercises for home? If she's still under an ortho trauma consultant they should be able to instigate a physio for her?

It's true it might take a while so if you can afford it then maybe do go private, at least initially. They are usually about £100 p/h or more for home visits I think.

Is she able to get to the bathroom and use toilet unaided? Could she do that before?

Absolutely private physio, the earlier the better! Longer they are less mobile, the more muscle wastage, the more fear.
Can look on Chartered Physio website to find them near you.

Yeah they did, but my dad has lost them 🙄, I'm calling the hospital now to check.

No follow up with the surgeon planned, just a chest scan in 6 weeks

Yeah she could before, but now she's doubly incontinent, which is grim for everyone 😔

Thank you, we're booking this now

I'm sorry for you and her. I hope a physio can help her get a bit more mobile. I'm presuming the incontinence isn't directly linked to the hip surgery or recovery?

I'm glad you are booking private physio, definitely the right way to go.

My mother fell and broke her hip when she was in a dementia care home. After surgery and ten days in hospital, she went back to the care home and the carers followed the physio advice and got her mobilising again. Within six weeks she was walking as well as before she had the fall. So your mum may walk again but at this point she really does need physio help. If she sits in a chair all day she will lose muscle mass as well as losing the sequencing ability to walk. Best of luck.

@DiscoBob thanks, I hope so too 🤞

Not directly linked, no, but I think a month in hospital has worsened her dementia considerably 😔

It is very difficult to do physio with someone with dementia as most of the work is done by the patient when the physio isn't there.

If the dementia has caused loss of motivation or they aren't going to remember to do their exercises rehab will be difficult.

If she has the sort of dementia with a drive to wander the whole time however she may just rehab by herself.

Carers to implement physio advice daily is going to be the best way to spend your money.

Private physio all the way.

A relative broke her hip and when clearing her papers after she died, I stumbled across a letter which said the cause of her back pain was ‘insufficient rehab’. It broke my heart to read it.

@catofglory thank you - that gives me hope!

We have a private physio booked for Sunday 🙂

Oh god that's awful!

@AnnaMagnani thank you that's a good point. My dad is at home with her but I don't think he has the confidence or personality to push her to do the exercises if she's not keen. Hopefully the private physio will help! She currently seems to have the sort of dementia where her only "drive" is to doze all day, but we'll see if that changes now she's home...

I'm on a couple of FB groups. Mobilise is one, the other is Carents Lounge.

I do snooze them from time to time as I find it depressing to see the scale of the lack of support from the State. We really are abandoned by SS and the NHS. At least we are all in the same boat, small comfort though.

They are a good source of support though, if sometimes overwhelming.

It's pretty normal for patients to do more for strangers than their own family. You need a no nonsense type carer.

Yes yes yes.
motivate physio as much as she can afford. Much more hands on / personal than most nhs physios and keep it going long term if you possibly can. apart from anything it’s be to one social time that isn’t family which is do beneficial

I have had a couple of elderly relatives with hip fractures , one also had dementia.

What I suggest is that you make sure she has a bed sore prevention mattress and a bed sore cushion as if she is in bed for long periods or sitting she is at real risk of developing bed sores. You can get these on the NHS but they only tend to give them out after the relative has got bad sores.

My relative with dementia ended up with additional falls and injuries because the dementia meant he did not feel or understand the pain in his hip. Hope that is not relevant to your situation.

If funds are not an issue some private care homes have physios and will do a daily regime in the care home and help get her continent again and fit enough to return home - just a thought as others are right in saying that it is repeating the exercises that is important and your father may struggle with that and most carers will say that physio help during their care time is outside their scope.

So she’s having doubled up carers 4 x a day? How is she transferring from an to b atm? With what equipment and with what level of help? How long does she sit out for? What type of hip operation did she have? IM nailing, DHS,THR? Is pain well controlled? Is she eating and drinking sufficiently? Does she have any specialist equipment, profiling bed, tilt in space chair etc? Is she able to follow simple instructions? How long ago did she have the op?

people do tend to recover better at home, especially those with dementia. But depending on the answer to the above questions, will incite the level of rehab she will tolerate / be fair to put her through.

Have missed that she already has 4 double up calls a day.

Unfortunately OP I think you need a physio who is prepared to be very blunt with you about her realistic rehab potential. It may be a lot less than you are hoping for.

spent a lot of years anaesthetising patients with broken hips....it's tricky for patients with dementia. As per @AnnaMagnani , the wanderers may well rehab themselves a bit (so long as they don't fall over again) but if motivation/energy/focus/nutrition etc are lacking as part of a cognitive impairment rehab potential is limited. It used to be that you'd anticipate a step deterioration in mobility for in the patients starting from a frailer baseline. A lot will also depend on other medical issues - it's often an injury that happens as a symptom of other medical issues and those may become the limiting factor in rehab (the reason for the pending CT scan may be significant here). Ultimately, a broken hip is still a life threatening injury despite progress in surgery, anaesthetics and peri-injury/operative medicine - for some patients rehabilitating mobility is a massive ask.