Should my mother with late stage Alzheimer's under Hospice care have hip surgery?

My mother had late stage dementia---I believe it was frontal lobe, but who knows?---and was talking to dead people and reliving scenes from her childhood in the final months of her life. She passed away last November under these circumstances:

She fell and broke her hip. Doctors were leery about a hip replacement at her age (95) with heart issues, but they said if she didn't have the surgery she would spend the rest of her life, however brief, bedridden and on pain meds. Waiting to go into surgery she complained of stomach pains. My brother tried to alert hospital staff to this situation, but they ignored him and operated anyway. The surgery was a success, but the stomach pains turned out to be an infection. Since she was on post-op painkiller she didn't complain about her stomach, but the infection was just getting worse.

Several days after being released from the hospital, she had to be readmitted. The hospital personnel, naturally, were not going to admit to negligence. They treated the infection and sent her back to my brother's house to recuperate and start physical therapy. Several days later she was back in the emergency room with pneumonia. Back to brother's, this time with hospice assigned. She passed away within the week, the last few days semi-comatose. Remember they warned that she would be bedridden and on pain meds if she didn't have hip surgery? Well, in her final weeks she was bedridden and on morphine. You can guess what MY opinion is about the whole medical ordeal she suffered through. :(

My mother broke her hip in a fall in the nursing home about a year ago. The doctors said it was broken in the best possible place it could be broken, if you know what they meant, and it could be repaired with a pin with minimal invasion. So they did that, she was in the hospital maybe 3 days and then went back to the nursing home. She got a little therapy there when it healed. They said they could do nothing with the hip but if they repaired it, she could at least stand up with some help and not just be dead weight in bed that had to be shifted around like sacks of flour. She healed up well and passed away from dementia a year later. That was just my experience, she was fortunate that she didn't need a lot of finicky surgery. Because the doctors will tell you sometimes it's better to just leave it as it is, and just control the pain.

I wouldn't do it.. keep her comfortable in hospice... thats a major surgery...

Hip fractures usually mean the demise of the person. She is on Hospice. Why put her under for hip surgery? That sounds risky.

As a RN and a wife of a dementia (FTD) patient who is advanced, if she can be made comfortable with medicine and positioning I would not do the surgery. Talk to your Dr and get all the facts. I would not put my husband through this surgery, cataract surgery, etc at this point, it is like why? He would be picking at the dressing, pulling the IV out, he would need constant surveillance which the RN's now days are not able to do. It is a very hard decision. But a lot can be done with pain meds to make her comfortable if needed and positioning. I'm sorry you are going through this.

My 83 year old mom fell in assisted living and broke her arm. She, too, suffered from Alzheimers. The doctor said if mom didn't have surgery her arm would heal deformed. He also alerted me to the fact that the anesthesia might make the alzheimers worse. I opted for the surgery. She survived for 5 weeks and passed away at hospice. I would NOT do surgery and control the pain. Living through this scenario, if I could take back the surgery I would. Best wishes.

If she is on Hospice she will have to go off Hospice to have surgery. Once she returns home she can go back on Hospice.
She probably will not have rehab since she can not walk.
Sad truth is even with surgery she probably will not survive more than a month.
What I would do is not do surgery, with the help of Hospice keep her pain free for the duration, probably a few weeks.

If she can sit up to eat and does not seem to be in pain, there might not be any advantage to surgery for the hip fracture. You would be able to tell via facial expression or resisting movement that it hurts her. Treating osteoporosis may be too late but might be a consideration too. Sorry you are in this spot!

Thanks to everyone for their honest answers. My mother is 89, and in good physical health, other than the Dementia. If this had happened a year ago when she was still walking and talking, I would go for the surgery. She started refusing to walk last March and that is when they put her in a wheelchair because she was such a fall risk. We tried lots of PT AND OT first, it was like she can't process the steps of walking. Same thing has happened with eating. She lost a lot of weight and almost died in August and we couldn't really identify a cause for the decline but possibly a mini stroke. Then in Sept to Nov had a recovery. Eating finger foods and feeding hersel. Still not talking or walking but responding to music and very alert. Nodding her head to answer questions. Then she had this fall, and had started to decline again. I think the surgery would not be a hip replacement but would be resetting the broken bone with pins ad wires. Based on your advice and consults with friends, my next action is a consult with a Dr. To see if they would even consider the surgery and how involved it would be. Thank you all for answering. While the information was valuable, even more important was the comforting feeling that I was not the only one having to consider such s difficult decision.

This is a very difficult decision and partly depends on her general condition rather than necessarily the amount of pain she is experiencing as this can only be assessed using non verbal signals. For example is she still eating well even if she has to be fed. Getting her walking again is probably a lost cause after so much time bed bound.
Having the surgery may indeed lead to death but then so may the use of narcotics to control the inevitable severe pain. As there is little prospect of her walking again would it be possible to stabilize the bone without a complete hip replacement. It does not need to be functional just stable. Going back 50 years before hip replacements were the norm a patient like this would have a fracture stabilized with a kind of splint that kept the leg stable while the break healed. If anyone is interested I can describe it. The patient would be bed bound and I don't know how well rehab went but know a lot of PT was done in the pool.
Any surgery would probably be done using spinal anesthesia and heavy sedation. The patient is totally unaware but continues to breath on their own without the need for intubation and general anesthetics which does reduce the risks.
It may of course increase the level of dementia but that is a necessary risk.
Hospice can of course give enough narcotics to control the pain but determining how much to give is always difficult depending on non verbal signs. She will probably be pain free lying still but it is doubtful if she can be moved without giving significant pain and naturally the risks of things like pneumonia are greatly increased. There is also the problem of healthcare professionals and their comfort level in the amounts of narcotics they are comfortable using this applies to both nurses and Drs.
To suamarize end of life dementia patients usually refuse to walk so rehab will only consist of bed range of movement exercises as tolerated.Depending on patients quality of life and the desire of relatives to prolong life my inclination would be to go for the surgery if the surgeon and anesthesiologist are prepared to under take it and a hospital DNR is in place. There will be pain after the surgery but probably only for about six weeks which can be controlled with less strong analgesics. You know your loved one and their desires when well so be guided by this knowledge and ask a lot of questions. Whatever you decide she is nearing the end of her journey so don't let guilt decide you.

My mom had hip replacement at 85 and did well but she didn't have alz. My instinct in your case would be to let it go since if the pain can be controlled and she is not mobile anyway.

Hip breaks used to be the beginning of the end for many elderly. That is no longer the case. Alzheimer's adds another complication making rehab impossible. Like, Jeanne, I would opt for meds to control the pain. Even under a local anesthetic would be very difficult for your mom. Wouldn't there be a preauthorization necessary? My stepdad had hip replacement at 85, he did not have dementia, and did well in rehab, lived five more years. This must be very difficult to decide.

Tracy, I'm so sorry that you are going through this! We faced something similar 3 years ago with my mom. She broke her hip near the joint post stroke and couldn't tell us she was in pain. An alert PT figured it out. She had the surgery under some sort of local anethesia and rehabbed pretty well. her dementia was not as advanced as you mom's.

at the time, I resigned myself to the fact that we might lose mom during surgery, but leaving her bedridden in pain was not an option for us.

Hospice should be able to control the pain. That is all I would be concerned with.

Wow this must be agonizing for you

I have a friend whose mother was late stage Alzheimer's and fell and broke her hip and she actually had to fight with the doctors to perform surgery but her mom was in a lot of pain

Have you asked the doctor what he/she would do if it was their mother ?