Broken hip + Alzheimer’s= Possible outcomes?

My MIL who is 84 today had a fall yesterday and broke her hip. They are going to operate to fix the hip but as she has Alzheimer’s and from a quick Google today it seems that the chances of recovery are lessened in this scenario. I’m guessing that a general anaesthetic and a fairly intrusive operation at 84 isn’t ideal anyway but with fairly advanced Alzheimer’s that complicates things further. Does anyone on here have any experiences of similar? Just trying to prepare ourselves for what may be the most likely outcomes.

My mum did hers at the sameor even older age (also with dementia).  I’m pretty certain that they gave her a general anaesthetic as theyy’d have worried she wouldn’t keep calm/still with a spinal.

I honetly don’t think the surgery affected her AD but the MONTH in a busy, stretched acute hospital while she recuperated probably did (not sure the prolonged morphine helped much either).  She did walk again but never massively stable (and falls risk is raised with AD as you probably know).  She’s still going at 93 but really doesn’t walk any longer – she’s in a home, so not bed-bound as they can hoist her on to chairs.

I genuinely think that she has had zero pain at any point after the initial post-oip recovery – whenever I asked her to guess which hip, she’d really struggle aalthough the one with the prothetic joint did feel different

I’d be asking about rehab plans if I were you

Sorry to hear it… We did this twice, well, once with midstage alzheimers and once with early stage dementia. Grandad was early dementia, tbf he got a replacement and shrugged it all off like it was nothing, was back in the garden a week later terrifying us. It was all pretty sketchy as he’d literally forget that he’d had surgery during the recovery, and also kept losing his zimmer frame.

Grandma was diagnosed alzheimers and tbh by the time of the fall was already pretty far along, could remember people more or less but couldn’t follow a conversation or remember what happened yesterday, would lose track mid-meal, stuff like that. She didn’t adapt well at all, surgery went well enough but she just couldn’t figure out afterward what had happened or build it into her life, there were problems from the moment she woke up and tried to get up and leave, but once she was as healed up as she was going to get she also couldn’t adapt to the loss of mobility, and I think there was quite a big element of shock/trauma and loss of routine from the hospital stay, it was pretty much the beginning of the end. TBH that was on the way anyway but it definitely sped it up.

Oh yeah and I broke mine and got it fixed with bolts but I don’t have alzheimers, I’m just not very good.

Good luck, alzheimers is bloody awful.

My FiL broke his *elbow* at the end of last year and never walked again, so good luck getting any sort of meaningful physio and support from today’s NHS.

Her Alzheimer’s is quite advanced now, we had to put her in a home 3 years ago. She’s quite settled in the home and definitely isn’t keen on her routine being disrupted. She was already quite unsteady on her feet so it was only a matter of time before something like this happened. Getting any kind of mobility back is wishful thinking really. I’m more concerned about deterioration in the Alzheimer’s as a result of the operation/trauma.

The only thing I’d say having worked for a few years in care is as much as possible get her to weight bear ASAP (I obviously understand the difficulty of this) because the amount of elderly people who do similar and don’t walk again is extremely high.

You need to speak with the Team in the hospital. They will in theory already be planning her discharge and you need to be involved in that as to whether she can go somewhere with the same level of care or needs more

Speak to the nursing staff to get their views. If it’s a good hospital they may even have a discharge coordinator on the ward

Unfortunately, the mortality rate in older folk following hip fracture is appalling. Comorbidities make it worse. I wrote my OT research proposal around this topic, and would suggest that an experienced OT can make a real difference in this scenario.

We are going the same with my FiL. Dementia for a few years; progressively worse falls until he eventually broke his hip. Now looking for a care home. His dementia is getting worse but I think this has been more to the changes in his environment: home, hospital. nursing home, etc. I’m frustrated that the social worker and OT involved in his care are f*****g clueless.

Just bear in mind that if she is much worse mentally directly after the anaesthetic, that might just be postoperative delirium, which should fade over the few days afterwards, rather than a permanent decline.

Hope it goes well for her.

I would echo some of the above, be prepared for further cognitive decline due to the upheaval and disruption of a chaotic hospital stay

Be prepared for personal stress due to chaotic hospital organisation.

Hope for the best and prepare for the worst springs to mind but dementia can have you in a moral tangle with that saying.

As Stanley states above broken hips are a real killer for the elderly and we’ve been through it twice. I think the first 12 months sees them at considerable risk.

My grandmother in law broke her hip and had an op to fix it at 100, ultimately it wasn’t this that did for her and the operation was a success.

My father broke his hip at 83, he was suffering with dementia at the time although it wasn’t too bad, he was reasonably communicative and he had been relatively mobile.  He never walked again and had a very marked decline, dying one year later in a home having been living at his own home up until the fall. They care staff tried to get him to exercise and rehabilitate but he just didn’t / wouldn’t engage and eventually closed in on himself. I suspect having been active and a hard grafter all his life he also gave up to a degree.

As mentioned above be all over the care plan and discharge strategy.

One thing I’d add to this,

You need to be VERY CLEAR to the hospital that she has dementia/alzheimer’s. That she is not a reliable witness if they’re asking her questions. My experience is that a hospital is good at dealing with physical ailments, and good with mental ailments, but if you’ve got both then there is absolutely no joined-up thinking.

When my dad lost his mind through vascular dementia, they stuck him on a surgical ward to treat (horrible) vascular-related wounds. We’d go up to see him, talk to the doctors/nurses etc and say “you do know he’s got dementia don’t you?” and they’d go “oh, we had no idea!” This went on day-on-day for months, it was horrendous. They’d come to check on him and ask him how he was, he’d be like “oh, great, I’ve just been down to the shop for a paper” and they’d reply “oh, that’s excellent, you’re doing really well!” but it was nowt of the sort. He’d imagined it / made it up, he couldn’t walk from the bed to the ward’s en-suite toilet, but he was so convincing. He should’ve been on a mental ward, but then who there is going to change his dressings?

Slightly more positive from me,  my great gran in law broke her hip while suffering from vascular dementia. She’s still pretty mobile approx 3 years on approaching 90 years of age, although she uses a walker frame thingy. Obviously the dementia is not getting any better but she recovered reasonably well from the hip.  She’s stubborn as a mule and won’t accept help getting dressed etc so no doubt will fall again at some point, but I think that did help with recovery as she wanted to be up and about.

Unfortunately, the mortality rate in older folk following hip fracture is appalling

DOI first – I am a consultant anaesthetist and spend most of my Fridays in the trauma list.

Unfortunately, people who break their hips fall into two categories – young people with a high-energy injury, and elderly people (who may be less steady on their feet, have reduced bone density etc.) for whom it’s an injury of frailty. It’s major emergency surgery (the fracture needs fixing within 36h and ideally within 24h) or the risks of pressure sores, pneumonia and so on increase dramatically.

We used to quote 1:10 mortality at a month and 1:3 at a year (with surgery – without is much, much higher), though I’d expect most units are better than that now, according to our lead surgeon, ours is. People usually die of their underlying health conditions rather than because of the surgery, which again is a reflection of the frail, elderly patient group who break their hips. Last time I looked at the evidence, there is no survival benefit to favour spinal over GA or vice versa.

The bigger issue may be that people with dementia tend to get worse when taken out of their normal environment, and this may result in an increase in care needs. As @funkydunc says you need to be speaking to the team in the hospital, who should be talking to you about everything.

Good luck with all of this.

The fall happened on Tuesday afternoon/evening and she’s being operated on soon so she might just sneak under the 36 hour.

Really sorry to hear this, a world of pain and aggravation follows for both the patient and their supporters…

My Mother, at 83, broke her hip in August 2023 and never properly recovered. She struggled to weight bear before and this compromised her recovery. She spent probably a month in hospital, 6 weeks in a nursing home then 8 months at home bed bound being visited by Carers 4 times per day. She was adamant she wanted to be at home and was considered to have Capacity. She died in July 2024. IIRC the stats I Googled at the time of the fall, had something like 80% mortality within 12 months for the over 80’s but I may be misremembering. There’s too much involved to repeat here but if the OP wants to engage 1:1, happy to talk through what went on. Summarised by ‘horrible from start to finish’.

In contrast,  MiL at 89 broke her tib and fib a few weeks ago – I know it’s not a hip but a pretty significant injury nonetheless. She spent 3 weeks in hospital then 6 weeks in an NHS Intermediate Care bed. Then home bed bound for 3 weeks and now increasing her mobility. She’s a tough old bird, determined to be independently mobile again and is making progress towards that. Again, she had limited mobility before her accident so the aim is to get back to that.

Neither of these people had/have Dementia or Alzheimer’s which is just another level of buggeration and complexity to deal with. The short version is, recovery depends on the individual’s circumstances and their motivation but may be much (probably ‘will’) more difficult to manage with the added mental issues.

Bon courage.

I’m glad that someone else has already made the 24/36 hour point.

OP be ready to advocate and raise a formal complaint if it doesn’t happen. Too often hip fractures are treated as low priority on emergency lists, and the sooner if gets fixed and the sooner she gets walking again, the better the outcome.

Too often hip fractures are treated as low priority on emergency lists,

With due respect, I’d expect an acute hospital of any size to have a dedicated trauma theatre 7 days a week (we, in a large DGH, have two trauma theatres), so the 0830 NCEPOD prioritisation debate shouldn’t apply here.

Otherwise agree, in general, the sooner it’s fixed, the better the outcome (allowing for health conditions that need to be optimised before it’s safe to proceed).

@ratherbeintobago

Glad to hear that it’s becoming more common.

@Kramer I’ve never worked anywhere that didn’t have a dedicated trauma list (even one sleepy DGH that I worked in that didn’t have a NCEPOD list still had a trauma list, albeit half a day) and looking back at “Trauma – Who Cares? (NCEPOD 2007)” even then it was far, far more common than not – 139 of the 177 hospitals surveyed had one

Are they going to fix the hip by screws/metalwork, or go straight for the Hip Replacement?

Having had a broken hip, and being in the ‘broken hip ward’ at 39, with many others in their 70s and 80s. At that age, it was straight to hip replacement stage.

My hip took varying stages of care with non weight bearing, partial weight bearing etc and relyed on the body to fix/generate bone. I beleive that wont be needed with a hip replacement.

However, from my experience with the folks on the ward and speaking with the nurses, they said at that age and level of surgery (even with no dementia) many would be bed ridden and indeed many had been there months and months still in hospital recovering.

I was in 2 days – fitted with Dynamic Hip Screw – fixed 14 hours after injury (partial displaced), with obvious risks of AVN and non union.

So hip replacement (im not a doctor) from my experience seems to be the less aftercare option for an aged patient.

Edit to add from Fossy – there was one aged man on the ward after surgery who – i can only presume had dementia – the staff would have to sedate him every so often to stop him from disrupting others sleep and to stop him moving aggravating the surgery/repair in the short time i was there. He took up so much of the nurses time for them to try and keep him calm.

The hospital staff will need to be aware of the dementia/alzheimers post op. I was in a spinal ward for over 6 weeks myself, and the chap opposite had had a fall, broke his spine, but hadn’t a clue where he was and why. There weren’t enough staff to keep an eye on him, and I was constantly hitting the call button as he was getting out of bed, wondering where he was (we were on confined bed rest, no moving). Poor chap had no family. They did eventually have to pop a HCA sat at the end of his bed overnight so the others in the ward got some sleep.

Post operation will be difficult. Best wishes.

Are they going to fix the hip by screws/metalwork, or go straight for the Hip Replacement?

Again, with all due respect, this is a decision for the surgical team, and there are several options/considerations which will depend the type of break etc – Dynamic hip screw vs intermediate femoral nail vs cemented hemiarthoplasty vs uncemented hemi vs THR.

None of us here are in a position to advise on this one.

(As a total aside I was at the open day for the school Sir John Charnley went to a while back, and what was presented as an example of a Charnley THR was, in fact, a Thompson’s hemi. This is the limit of my ability to recognise these things)

@ratherbeintobago

Yeah my orthopaedic experience was 25 years ago.

I’d worked in a very good trauma unit (Nottingham) and then locumed as an orthopaedic SHO in other smaller units, and was horrified to see how long some #nofs were left languishing in the other units.

It’s good to hear that things have changed for the better.

Operation has been done, probably more like 48 hours since the fall unfortunately.

Good news, now onto making sure she can recover OK given limitations with memory. Best wishes !