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Eaglesmom 02-06-2012 04:56 PM

Mom, 81 Broke Hip
Mom is 81 and diagnosed last fall with vascular dementia. I am frightened by how fast she has declined.

I have tried everything - homecare (I live 2 hours away) but she abused the caregivers and fired them; living with me (she called 911 and reported my husband for kidnapping her), and finally a memory care facility where she fell and broke her hip Jan 31.

On advice from the hospitalist, I agreed to surgery. Mom was released today from hospital to a SNF for rehab. This afternoon she was combative, aggressive, loud, threatening. I despair of her ever agreeing to do rehab in which case this will no longer be paid for by Medicare. The Memory Care facility she was in will not take her back needing skilled nursing. So once again I will in search of a memory care bed - this time at a SNF.

I am so frightened of her harming herself - reinjuring the hip. I dread every waking moment. I need help and advice from someone who has walked this road before me.

Gabriel 02-06-2012 05:39 PM

Re: Mom, 81 Broke Hip
Eagle, sadly this is not an uncommon story. Vascular Dementia can move slowly or very quickly depending on the condition of her vascular system. The trauma of the broken hip, the pain, the surgery, the anesthesia, and waking up not being able to walk on her own are all terrifying and will only make her cognition worse. It is standard procedure to move a hip repair to rehab but most rehab facilities are unprepared to deal with a dementia patient. You Mom is reacting to all she has been through and truly needs the help of a good geriatric psychiatrist who specializes in dementia behavior to evaluate her medications and find a combination that will calm her without sedating her. It is possible.

Your Mom is in emotional distress. What if you woke up with people trying to make you do things that hurt when you had no idea why you were there or what had happened to you? You would fight aggressively, threaten loudly, and try your best to get out of there! We treat physical pain quickly but tend to be less aggressive with emotional pain. Your Mom is in emotional pain. The quicker you get help for her emotional pain the better off Mom will be. Please talk to her doctor about a psychiatric referral to a geriatric dementia specialist in psychiatry. Once Mom is calmed the rehab will go better and she will be more acceptable to a memory care bed.

Ativan and Xanax are not the medications that your Mom needs. These are sedatives that do nothing more than put a bandaide on the problem. THere are other A-typical anti psychotic medications that do work. There is a slightly increased risk of cardiovascular complications with these meds but the blessing of contentment outweighs the risk!!

My Mom has never had a broken hip but I have been through the aggressive, combative, hysterical behavior with her. She spent 10 days in a geriatric psych facility and came out alert but chemically content. That was almost three years ago and it was well worth it. The smiles I received from her today made it all worth while :)

Love, deb

mitsy 02-07-2012 07:20 AM

Re: Mom, 81 Broke Hip
I agree with Deb, finding the right cocktail for your mom so that she is settled and happier is the right thing to do. Facilities cannot handle the agression, caretakers can't handle the aggression and you cannot handle the agression. It's too much and at that point you are left with know options except the worst kind. Having her medicated correctly is not bad and would probably make her feel more comforted too. My husband's family always turn a blind eye because they don't want to face anything. My MIL did chase away a caregiver, make that two and threw an object at one of them. Right now one is working but she's going through money like everything and in the end they'll have to put her in a home not based on selection but what medicare will put her in. The family says "what if we medicate her and it kills her" For real? AZ are in such a hyped up state that even pschotic medication isn't much. Doctors that deal in geriatric issues and AZ can work this out. My prayers go out to you.

Gabriel 02-07-2012 09:18 AM

Re: Mom, 81 Broke Hip
One thing I will repeat is that treating the aggression and other psychological issues is more for the loved one with dementia than for anybody else. If they are distressed then they are emotionally miserable. We do not want our loved ones to be miserable. We want them to have contentment in these finally years. The deserve that contentment as they journey through this horrible disease. So do Mom a favor :)

Love, deb

jagsmu 02-07-2012 09:37 AM

Re: Mom, 81 Broke Hip
I am sorry that you are going through this, the journery that you are on has only one ending, the trick is to find the smoothest path for all..and if the right cocktail of meds helps ease the fears and chase the demons away then go for it...


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