My mother stopped walking due to Alzheimer's cognitive decline about 9 months ago. She fell out of her wheelchairs at assisted living and broke her leg bone where the bone connects to the hip. Our options are to continue Hospice and treat with pain medicine or have surgery. My mother stopped talking 6 months ago so there is no way to tell how much pain the broken bone is causing but it was discovered when she expressed pain being moved. Either way I feel like she will be bedridden as there is no way PT or rehab will work since she refuses to walk. I feel taking her out of a familiar environment and exposing her to ansthesia will all kill her or make the disease progess. But doing nothing about a broken bone seems heartless too. Has anyone else faced this decision?
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. :(
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.
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.
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.
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 ?