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Advanced Alzheimer's and Potentially a Broken Hip

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Old 04-29-2012, 09:13 PM   #1
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Advanced Alzheimer's and Potentially a Broken Hip

My dad has advanced Alzheimer’s. And since my mom, his caregiver, became ill he is declining faster. It was kind of strange. She has been away from home, and back and forth between the hospital and the nursing home for ten weeks. She actually may not survive her illness. The first few weeks were a little tough on Dad. But in the last few weeks he has gone downhill very fast.

I have a question about hip fractures, which I believe he is at a very high risk for. He is seventy-eight years old, six feet tall, and weighs about 135 or less. He is a walking skeleton in clothes. He has fallen several times lately without even a bruise---amazing. But I fear it will happen any day, unless he breaks something else first.

My Dad’s medical directive says something along the line of, “If I am ever diagnosed with Alzheimer’s, have a stroke, or other brain injury, <<(notice that comma placement), AND I develop any other ailment which would likely end my life, then do not treat whatever the problem is and simply administer palliative care.”

Now I have read several definitions of palliative care online. Some indicate healing and some sound more like hospice care. I assure you my dad’s intent was toward hospice care.

Right now my mom is still calling the shots from a nursing home bed. She says that if Dad ever falls and breaks a hip that he will not receive any surgery. She says that at his stage of Alzheimer’s that he wouldn’t do what is required of him as far as staying immobile right after the surgery anyway.

I have read some heart wrenching stories about broken hips with the elderly---the pain and suffering that they endure. There seems to be a high probability of fatal complications, such as infection or pneumonia.

All I know is that my Dad really is in the advanced stages. Physically he is just barely able to get around. I truly believe that without a fracture that if his physical deterioration continues at the same rate for another month that it has in the past month that he will be in nursing home. Mentally he has just about “left the building”.

I guess my question is this, should he break a hip, do you think it would be right, proper, etc., to not administer any treatment other than pain medication? Is she right that an Alzheimer’s patient isn’t even a good candidate for pinning a hip, or whatever other surgical treatment that might be warranted? Which route would be less painful? I wouldn’t necessarily want to prolong his life.

I just want my Dad’s exit to Heaven to be as painless as possible—period!!

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Old 04-30-2012, 12:57 AM   #2
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Re: Advanced Alzheimer's and Potentially a Broken Hip

Hi Danny,
Please excuse my typing--I'm on my kindle tonight

My Mom has had two hip fractures and two surgeries--the first one was what really started us on the dementia merry-go-round. She's 89 by the way (which makes your Dad a relative youngster )

I know it isn't going to ease your mind to tell you this, but you'll figure out what to do if and when you get there. It all depends on the severity of the break, your Dad's overall health etc. etc.

To answer your question, in my opinion it is sometimes absolutely right and proper to decline surgery and only provide pain relief. On the other hand, sometimes that's not the most merciful thing, either. Surgery can actually be less painful because you don't have to wait for the break to heal. They're up and rehabbing within a day or two--it's unreal.
Bottom line:
You just do the best you can when you get there, and try not to get too far ahead ofyourself

Old 04-30-2012, 04:05 AM   #3
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Re: Advanced Alzheimer's and Potentially a Broken Hip

You have a lot on your hands and I understand completely your concerns. I think you answered your own question in the very last line of your post. When and if the time comes, you will choose what is right for your dad. He is lucky to have you for a son. Try not to worry about things that may never happen as you have a lot on your plate as it is.

Old 04-30-2012, 11:41 AM   #4
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Re: Advanced Alzheimer's and Potentially a Broken Hip

Danny... welcome back

Kern is right... when the time comes gather all the information you can get and you will know at that point what the right decision will be. It is so very difficult to predict in the future what the situation will be. There are so many variables that you don't know now. What your Dad' mental and physical status is will be critical. How bad the break is will be another critical factor. Will the surgery alleviate pain and suffering? Dad may not lay still after surgery, but will he stay in bed with a fractured hip for the rest of his life. Both subject him to a greater possibility for complications. Your Mom is right that any surgery will be difficult for your Dad but there are so many factors to consider that you will only know when it happens that a blanket decision now is not possible.

My best advice is not to worry now about what might happen in the future. My dad fit your description of your dad.... 6', 135 lb walking skeleton falling but managing to be ok. He did hit his head once hard enough to have a slight brain bleed but it self resolved. In all his falls he never broke anything. The body may have been fragile but the bones held up well. Beyond that I figured out that for all his tall thinness... he was very adapt at controlling his fall so that he didn't get hurt.

Hopefully the same will be true for you So try not to worry too much about what might be. You have enough in the here and now to keep you busy!!

Love, deb

Old 04-30-2012, 12:10 PM   #5
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Re: Advanced Alzheimer's and Potentially a Broken Hip

Like everyone says here, deal with it one thing at a time. Is dad in the wheelchair? If he is in the wheelchair, it is safer for him not to fall. If he is on a cane/walker, then it is dangerous for him to fall. Just try the best to prevent his falls and you will see.
When my FIL started his walking problem last May, the NH was worried about him falling. Guess what, he got used to it and knows that he does not want to fall! Now he is in a wheelchair. Somehow the walking/falling is not the major issue now - it is the eating of pureed food - they have to puree everything!
We do have many future issues to think about. But my Mom told me wait until it happens! Some stuff may not happen! I was worried about hospice if my FIL stops eating but he is still eating. So we don't go there until it comes.

Your Mom is sicker now and I hope she will get all the comfort she can get.
It is good that Dad has this advanced directive. But you will see at the time. It depends on how you will control his pain if this happens.


Old 04-30-2012, 07:20 PM   #6
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Re: Advanced Alzheimer's and Potentially a Broken Hip

hello danny, I have lived through what you fear!!! my mom broke her hip, she was well into alz. she was hospitalize and had surgery, all went well although the decline from the surgery was really scary, after four months in the hospital ( not due to the surgery, it went well and mom was up and walking the next day) just before she was being placed into a care home she fell and broke her other hip, we knew that having surgery was a big risk to her mental state but she was in so much pain that we had to have it done. she accually came out of the surgery well, meaning the surgery went well, the second hip replace but it was just to much on her mental state, she never really recovered mentally from the anastisia, 2 weeks after the second surgery mom just quit eating and drinking, it was then that we made the decission that no heroic mesures were to be taken... it was a tuff call, would I do it again, YES. was is gut renching YES. were there a lot of doubts YES.. but again I would make that same call... know that each person is different and you will know when it is time to make this type of call... don't look to far in the future and try to enjoy every moment with you dad that you can... if mom has the last say then so be it....

big hugs to you and your family.. judy...

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