Mom’s broken hand requires a splint, but she insists on removing it. What do we do?

So, at some point, we all get to the part of dementia where there are no GOOD choices, only the least worse choice.

What is worse, unhealed fracture and mom not being able to use hand? Or a couple of weeks of sedation and less than adequate nutrition? How would a temporary feeding tube be tolerated during that time?

Have you read Atul Gawande's On Being Mortal?

When my mthr was on hospice the first time, she broke her wrist when she was in about stage 6a when she was relatively able to do things for herself but not remember too much. The hospice nurse explained to me that she would try to remove a splint, and if they put a cast on it, she had seen dementia patients pick their own flesh bloody trying to remove the cast! She said the best thing to do was to let it swell which holds it in place and gave her tramadol for pain for a while and then tylenol. The tramadol made her stupid and not able to walk, but we wanted her to hold still and not reinjure herself and that was only for a week. Your mom is long past that week. I'd read Being Mortal and take the splint off.

My mom broke her finger and immediately removed the splint after leaving emergency room. We had doctor put a cast on as she wouldn't be able to remove it and would allow her finger to heal properly. She split the bone vertically as well as in half horizontally so it was a bad break. She didn't remember breaking her finger and didn't know why she had a splint on so kept removing it. She wanted to take cast off too so we kept telling her a special tool was needed that only the doctor had. This approach worked well for us.

Do you think she's removing it because (a) it's uncomfortable or hurts, or (b) it's unattractive, or (c) it's cumbersome?

If it's (b), I'd add a few ribbons, perhaps some small artificial flowers, so that every time she looks at the cast she sees something lovely.   

I know that casts can be inconvenient, though, and that's probably what irritates her the most.

- and unfortunately Tylenol is not at its most effective taken in that way.

Tylenol is better at preventing or suppressing pain than it is at relieving it once it's established. So if it's been prescribed at 1g x 4 doses daily, you'll find it works best if you take it just so - never less than four hours between doses, and never exceed four doses in twenty four hours. It is a very safe drug, but one drawback is that you don't have to take much more than the recommended amount to overdose; and then it's not safe, not at all.

You can get it in syrup formulations, might that be more acceptable to her?

I did, a little while back, meet an older lady who had refused to have her broken ankle set - no, don't feel sorry for her, she was not frightened or confused or too frail for surgery, she objected to the surgeon for reasons I'm embarrassed even to type and her daughter was mortified about. So, on that point at least, an idiot. Anyway; this had happened some years before I met her, and her ankle was an extremely peculiar shape, but the ankle was functional and not painful.

So the point is that it won't necessarily be the end of the world, or even the end of a functioning hand, if your mother doesn't wear the splint. Pain? - well, it's her hand. If the splint relieves the pain enough, she'll allow it to be fitted; keep offering, but allow her to refuse or to remove it.

I've no idea whether this would be justifiable or even possible clinically, but you could I suppose ask if anyone would be prepared to set her hand in a cast, rather than a splint, and see if that suits her better. As long as she doesn't thump anyone with it.

Have they said how long it might take to heal? I'm not convinced by the ethics of sedating your patient to make her compliant with your treatment. Pretty sure you're supposed at least to try to adapt your treatment to suit your patient, instead.

My MIL, while in her 80s and with dementia, broke or fractured her ankle. I can’t remember which now. She didn’t get medical care right away. I think she was limping about in pain. Finally after she was taken to the doctor, she was given a boot to wear.
She wouid remove the boot and when fussed at by her daughter she would throw it at her.
She also threw it at her dog when he barked. Somehow the ankle seemed to heal well even with the boot flying through the air instead of on her ankle.

Can the Tylenol be crushed into a food that she will eat so she does not realize she is taking it? Or better a liquid Tylenol that can more easily be taken. There are also flavored doses as well.
As to removing the splint can her other hand be placed in a mitten so that it is more difficult to remove the splint.
Or can the arm with the splint on it be left UNDER the shirt that she wears. This would also make it very difficult for her to remove the splint.

Tell dr she is able to remove the splint. Maybe he can just hard cast it so she can't get it off. For the tylenol, get some children's liquid tylenol and put in her cup when drinking water...or ask dr if there is another med you could mix with water or coffee to give the medicine.

Inform her physician what she is doing (removing the splint) and not taking the Tylenol. Get his or her recommendation.

+1 plaster if Medical team think is appropriate & will help.

She may be seeing the splint & blaming that for the pain.

Hopefully when the pain gets under control, she may leave the splint in place?

Best of luck.