My 85 year old mother lived in her home with some assistance from me i.e. driving, lawn care, etc. She fell around 12/10/21 and broke her hip. They "ball and stem" were surgically replaced the next day. After a few days in the hospital, she was transferred to rehab, did fairly well and was up with a walker without problem. She was released to home with PT, OT, and nursing on 1/3/22. She has no dementia etc., but has CHF, blood pressure, mid stage kidney failure. She has been physically failing a bit over the last year, but she is 85.
On 1/10/22, I noticed that she was falling asleep randomly and talking nonsense. She fell, bumped her shoulder and head....went to ER. They checked her out and sent her home within three hours.
She fell again a couple days later with no injury. I was able to get her up into a chair and up to the walker. The PT came and I chatted with her about the falls and her mental fuzziness. The home nurse was called and had her transported back to ER. The surgical site was infected (not noticable on the skin or temperature). She had surgery cleaned out the site and replaced only the ball. The surgeon felt she was not robust enough to do the stem.
She is now at another rehab facility with an IV antibiotic. Her hip has popped out twice and they have stopped doing physical therapy and immobilized her hip. She sees the doctor again in a couple of days.
I am having her mentally evaluated. She has gone from completely normal before 1/10/22 to either not knowing me or clear and combative. I think its the four rounds of anesthesia, two surgeries, and multiple moves in six weeks. The medical POA was done years ago but lacks physician signatures.
She is extremely frail now. If she has another surgery with would replace the socket, ball and stem. Her regular physician winced and said that was "alot".
If I secure the medical POA.....how far would you take treatment and intervention? I'm not sure she can manage the surgery but her quality of life is gone without the hip being repaired. If she's strong enough period. Quality of life is key....quantity of life in pain and misery is not. Adding I do know that my parents specifically wanted DNR and not feeding tubes. She has stated that she cannot do the pain (she has meds) and doesn't want to live in a wheelchair.
Sorry for the length....but she's gone from 100 to just about 0 within six weeks time.
Currently they clearly have a very unstable repair of this hip. Why there is so much easy dislocation I can't say. The fuzziness worries me from the standpoint of having to require anesthesia. While some doctors continue to refuse to believe that this is "a thing" the fact is that it is and most now recognize that fact. She is also in a weakened condition.
Right now you are in the whack-a-mole situation of dealing with "crisis" after crisis. Your Mom may survive this and move to SNF care or to rehab. She may not, but you cannot know now. Right now, if she is not resistant to antibiotic therapy infection may be fought back. It may not. I would not do artificial nutrition for more than temporary measure against her not being well enough to eat (she does need nutrition if we are still headed toward "healing".
If your Mom is ready to go, then do discuss if she would like to stop fighting on at any point to let you know and she can be interviewed by hospice. I think at best Mom is now looking at wheelchair and/or placement.
I wish you both the very best. I hope you will update us.
The whole thing is a damned shame given she popped back so well from the first surgery.
Even in a wheelchair with limitations, the assisted living facility I'm speaking with generally handles everything and has never had to send someone to SN unless it was a monetary reason.
I am so sorry that your mom is going through this.
I pray that she has a speedy, full recovery.
You say the 'medical POA was done years ago but lacks physician signatures.' That makes no sense as a POA does not require anything but your signature, hers and a notary's. No doctor signs a medical POA giving you decision making powers over your mother's medical care.
That said, I think you have to wait for the doctor's appointment to get the surgeon's advice on what to do next. I don't see how there's much choice in the matter; with an infection going on and a need for the hardware to be repaired or replaced, not doing so would likely result in her death, right? A DNR means she doesn't want to have CPR if her heart stops; that's all. Not wanting a feeding tube means she doesn't want heroic measures taken to prolong her life. This is something different, I think. This may require 1 more surgical procedure to fix and then she'd be ok, I don't know.
When I had full hip replacement surgery, it was done under local anesthesia..........an epidural, in fact. So I did not have general anesthesia, just a spinal which numbed me from the waist down. I asked to be knocked out with Propofol b/c I didn't want to hear or know what was going on for the 90 min procedure, but I didn't HAVE to be knocked out either. See if that is an option for your mom, the epidural so she's not given general anesthesia again.
I'm one who's all FOR allowing an elder to pass in peace at an advanced age w/o taking heroic lifesaving measures; but in this case, I'm not sure. The dementia she's experiencing now may not be a permanent thing; what does the doc have to say? If she's permanently suffering with advanced dementia and going to STAY that way, then maybe she's better off with no surgery b/c that's no way to live. But I'm sure that much of that goes with the territory for what she's gone thru and will resolve once she's healed.
Her 'regular physician' is not the one to consult here; it's the surgeon. S/he is the one to give you the final word on what the best option here is, or what the truth of the matter would be given both scenarios: to do the surgery or not.
Wishing you the best of luck with such a difficult situation. Sending a hug and a prayer; God bless.
I actually doubled checked with the attorney who wrote the document (they are painfully thorough). And that's what he told me.
i wish your mother and you well!
you know a lot more facts than we do...
and really, the doctors know best, what you should do...
when your mother is clear-minded, what does she say she wants?
my personal opinion is that your mother should go ahead with surgery/repairing the hip. it's very unlucky she had to go through so many surgeries in such a short time.
...your mother fell several times after seemingly doing so well after the hip operation. also very unlucky the surgical site got infected! :(
...she was given pills/injections for several weeks following the operation, to avoid infections, right? my LO was given pills/injections for many weeks.
my own experience with my LO was:
...after the hip operation, we helped every time my LO moved/walked. my LO used the walker, but there was always someone assisting, to make sure my LO doesn't fall again, soon after the surgery.
...2 months after the surgery, my LO was allowed to take some steps without someone watching (but with the walker, always).
i was with my LO at the time of the surgery.
the doctor explained to me that it was absolutely necessary, despite my LO's age.
without surgery, she said, my LO would be bed-bound, never walk again, terrible quality of life, die fast.
i signed the papers, and my LO was operated.
it was extremely fortunate that it all worked out for my LO.
i wish your mother well!!
even though getting yet another surgery is risky --- my personal opinion, is that your mother should go ahead and get the hip repaired.
then, get lots of competent physiotherapy/help to get your mother to walk again safely, with the walker. also pills/injections/precautions against post-surgery infections.
cognitive decline after surgery is common.
i really hope it's temporary for your mother. for my LO, the brain went back to normal some weeks later.
courage and hugs!!