Parkinson's + dementia + hip fracture

harriethomeownerApril 21, 2008

This is the situation right now with my MIL. She's 84 and in a nursing home. She has been walking very well for most of the year or so she's been there (in fact, she was the only person in the place who wasn't in a wheelchair), but over the past few months she's had several falls. The staff decided to keep her in a wheelchair so she wouldn't hurt herself, but they would come into her room and find her on the floor at various times. It must have been in one of these falls that she got the hip injury.

So here's the thing: the only real treatment for the hip fracture is surgery. I just can't imagine her going through the pain of surgery and recovery, including a long hospital stay, and then being able to participate in rehab. So what do we do? Which is worse: having her get the surgery with poor odds that she will benefit from it, or do nothing and ... what? She does have an advance directive, but I don't know if this falls into the untreatable condition category.

DH still needs to talk to the doctors. Perhaps it's not as bad as we're thinking it is right now. But has anyone here had experience with this? TIA.

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shambo

My mother broke her hip almost two years ago when when she was 91 years old. The surgery went well, but as you're suspecting, the recovery was difficult. She has a low tolerance for pain so that was a real problem. But the morphine left her very agitated and she suffered from sundowners in the hospital and had to be restrained and have a watcher. She spent a month in a convalescent hospital receiving physical therapy. She hated it and complained non-stop. Although she healed completely, the combined trauma of the surgery, pain, & staying in a strange place took its toll on her mental abilities. Since then her mental condition has deteriorated quickly.

Yet looking back, the idea of leaving her in pain from the break and permanently confining her to a wheelchair, unable to put any weight on her hip thereby making it even more difficult for aides to help her with ambulation doesn't seem right. Perhaps if she had a terminal disease with only a few months to live.

    Bookmark   April 22, 2008 at 1:06AM
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lindajewell

I would think she should have all the test to determine the extent of damage to her hip. Then talk to the doctors and make your decision based on her over all health. My brother is in advanced stages of Parkinson's, is getting the dementia from the drugs that Parkinson's patients get.........and is no longer able to get up out of his wheel chair. That is the horrible truth of Parkinson's, it does come to that point. He use to get up, like your mother, and fell several times. One time severly bruising his hip, but thank god there was no fracture or break.
Parkinson's patients always fight for their independence, not wanting to give in to their disease so she will continue to try to move, until the disease finally prevents her from being able to without assistance.

Talk to her about her choice, don't just make it for her. The dementia most Parkinson's patience have is from the long term use of the drugs to treat the disease. More often than not, the mind is still there, functioning and aware of what is going on around them. Most "normal" people do not realize this and therefore treat Parkinson's patients like they are totatlly demented. I know, I have watched it happen to my brother, until I stepped in as his advocate, now the folks at his nursing home see him for the funny, caring and awesome man he really is....

Linda J

    Bookmark   April 22, 2008 at 6:37AM
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agnespuffin

My mother was 86 when she fell and broke her hip. She had been in a NH for 3 years at that time. The doctor explained that the surgery was needed in order to get her walking again, however, the mortality rate from post-op pneumonia was high among patients her age. This was the case with her. Pneumonia started quickly after surgery and she died within less than 24 hours. I do not regret making the decision to let her have the surgery.

So your choice will be this....surgery with good recovery but possible death from pneumonia, or no surgery with little or no chance of ever getting pain free and mobile again.

Pneumonia is called "the old man's blessing" as it is an easy way to pass on. Ask yourself, if you were in her condition, which would you choose.

Pneumonia will probably be the thing that takes her out anyway. Sitting in a wheel chair doesn't improve lung function. It may be in six days, six months or six years, but at her age, the end is coming soon.

Sorry to be so blunt about it, but the choices are not going to be easy.

    Bookmark   April 22, 2008 at 7:20AM
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lindajewell

Basically what I was trying to say is that with Parkinson's mobility is going to go away regardless of surgery or not. The body will just quit working and the patient has no choice in the matter. Therapy will only do so much good after surgery because the disease will just take over any way. My brother is only 59, but his body will no longer allow him to get up out of the wheelchair without assistance, he has to have help feeding himself, dressing and so on. Speaking is becoming more difficult and eventually his ability to swallow will also be affected.

Please take all this in to consideration before making your decision, talk it over with the doctor's, pray and let Him guide you to the best solution for all.

    Bookmark   April 22, 2008 at 7:41AM
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harriethomeowner

Thanks for sharing your experiences. The orthopedic surgeon called this morning, and he said he wants to have another X-ray taken to see if things have changed since the X-ray they did a few weeks ago. At that time, there was no displacement. If things have not changed, then he recommends bed rest for about a month to let the fracture heal on its own. If it is displaced, he recommends surgery to avoid pain.

He said he knows that recovery is difficult in patients with dementia, but it really would need to be done.

So let's hope that all she will need is bed rest at this point.

Thanks again.

    Bookmark   April 22, 2008 at 10:17AM
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agnespuffin

That sounds good! Let's hope that she can handle the month of bed rest if that's what's needed.

    Bookmark   April 22, 2008 at 11:46AM
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