Aging Parents: 101-Year-Old, 4 Years After Broken Hip Surgery, Still Mobile and Living Alone

To begin the New Year, a happy follow-up–on Sr. Advisor R’s once broken hip.

Four years ago this month R left the rehab center after spending 4 months there. At the time Medicare only covered 3 months. Fortunately R had a secondary policy that helped with the 4th month. Don’t know what Medicare covers today. Do know that getting all information about insurance coverage, in advance, makes sense. It provides a framework for decision-making. That’s always helpful.

Today, at 101, R is completely mobile. She now walks with a cane when she goes out (which she didn’t do before she broke her femur). She uses her cane at home when she “feels unsure.”

While “feeling unsure” isn’t something younger people normally experience when walking or driving a car, it seems to be a feeling older people are attuned to. For example, I remember Edie (a Woman’s Club member in her late 90’s who aged well) saying something like “On days I don’t feel sure of myself, I don’t drive.”  “Know Thyself” seems important for aging well independently.

What has changed since R’s surgery:

R says she has no mobility problem–gets around fine, however–

The leg affected by her broken hip has never been as limber or as strong as it was before the surgery and is weaker than her other leg. Exercise is a must.

The muscles are weaker (even though she has religiously done the exercises learned in rehab since returning home). That leg also has less range of motion. For example, she says “I can’t just raise that leg (while sitting down) to put on a sock without help from my hand to rest my leg on a stool that I put in front of me. Then I can put the sock on.”

“If you don’t exercise that leg you’ll have trouble walking. So many just sit in a chair and don’t bother to do the exercises and pretty soon that leg doesn’t work so they walk less and sit more,” says R. “Many people just give up. I don’t want that to happen. I’m either going to be out of here (dead)–or I’m going to continue doing what I have to do. If you want your independence, you have to keep doing–your exercises and everything else.”

R credits the right cane (see next post) for giving her ease of mobility. She’s certain that the cane she’s now using is a big reason she’s been able to continue to go out with friends and live independently, alone. It was an important purchase that has helped her age well.

Check out “Newsworthy” (right sidebar). Links to timely information and research from top universities and respected professionals, plus practical information–to help parents age well.

Some Complications in the Year After Aging Parents’ Successful Broken Hip/femur Surgery

Aging Parents’ bodies do not bounce back as easily or quickly as younger bodies do. Obvious, yes–but legitimately worrisome never-the-less. See recent e-mail* below.

Hi Susan,
My 86 year old grandfather fell six months ago and broke his hip. Prior to breaking his hip, the only medical complication he ever had was diabetes. He made a swift recovery and was home walking around (with a cane) within a month.

A few weeks ago he developed a mild case of pneumonia, but recovered within a few days. Today he came down with a sore throat, which I believe could be a relapse of the pneumonia.

I’ve been reading through some of your posts regarding your mother-in-law’s recovery. I was just curious, did she experience any complications after recovery, such as pneumonia? I’m very worried. J.

Hi J.
My m-i-l says it took about a year before her body was back to normal. She never got pneumonia (she’d had pneumonia shots twice before). However, about four weeks after she came home from rehab she got bronchitis which required 2 courses of antibiotics. Not long after, her cane fell on her ankle causing a very small abrasion, which–after a while–got infected and required antibiotics again.

Then she got thrush (something I’d never heard of before–babies and old people get it, I’m told) and was given more antibiotics. She says “my body just didn’t seem to have anything to fight with. It seems like the body is just used up and is vulnerable.”

She had her physical in March (a year and about 2 months after getting out of rehab). Results: Everything–and every test (and she had a lot of tests)–came out perfect. She’s once again feeling strong and normal.

Of course everyone is different, but it seems that it takes a lot of time for older people’s bodies to recover from hip surgery (or any major surgery) and to ward off later “complications” as you call them.

An important key seems to be having a doctor who can get an older person through these complications. Your being a cheerleader (as well as a caring, involved person) has to help also. Susan

PS My mother-in-law (98) flies back here (2,000 miles) alone to see us in 10 days. Sincerely hope your grandfather will be doing as well in a year.

Hi Susan,
I cannot thank you enough for responding to me. While my grandfather lives next door to my parents, I live a few hours away. As you can imagine, it’s scary when you can’t see them in person right away. It turns out his sore throat was just the last bit of the pneumonia making its way out. He sounds a lot better now.

I was going crazy after reading all the “deadly complications” that can happen after breaking your hip. Thanks for the pneumonia vaccine tip, I’m going to mention it.

He’s been feeling a little bummed out about “feeling old” all of a sudden. But I’m going to see him this weekend to cheer him up and tell him all about your mother-in-law! She is a fighter! And I know he is too.  J.

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Clearly there can be complications; clearly some are very scary. A good doctor, who is experienced in treating older people, is so important.

(*E-mail was sent to my blog’s address and OK’d for sharing by J.)

Check out “Of Current Interest” (right sidebar). Links to timely information, research from top universities, plus some fun stuff–to help parents age well.

Do We Expect Too Much of Aging Parents?

Why Some Make the Effort, While Others Don’t

This was discussed over dinner with Senior Advisor, 98-year-old R, at a restaurant the other night. She highlighted how much harder it is to do every-day things with each passing year and the discipline and mental motivation involved–even for those who have (to use her mother’s term) “a good head on their shoulders.”

R was talking about the outstanding physical therapy she received for her broken hip in the rehab center a year ago, making it possible for her to get back to “normal”–albeit now with cane now, didn’t use one before. For more about Sr. Advisor, R, click tab above, hover over R.

R reiterated she’d rather make whatever effort it takes to live out the rest of her days without needing someone to care for her.  She said that fact coupled with ingrained discipline and an awareness that things don’t come easy, taught by her parents, account for her ability to remain independent and live alone. (No help other than a cleaning woman every two weeks.) I do believe it also accounts for her good health and successful recovery from surgeries and illnesses over the years.

R recounted not understanding why some in her rehab center physical therapy group made little or no effort to do the exercises properly after breaking a hip. Granted it was hard work…sometimes required more effort than she thought she could make, but she knew it was necessary to regain independence. Indeed it paid off.

The obituary of a patient from the rehab center who was mentally “sharp” but wouldn’t make the effort, according to R, had been in the paper. She’d known this person–a “lovely woman”–many years. R’s take: She was “spoiled” all her life and just couldn’t push herself to do all the exercises–which of course no one could do for her…a shame.

People change, not much,” a quote used in my previous posts, was our conclusion as we asked:
–Can we expect someone who never was a self-starter to initiate–be it friendships, advocating for him/herself, or whatever?
–Can we expect people who were undisciplined all their lives to be disciplined enough to do difficult things that are now in their best interest?
–Can we expect people who were basically disorganized to make a “to do” list and accomplish what’s necessary for their well-being?

These questions have implications for older people’s daily requirements, some as seemingly simple as taking medications on schedule.

Whereupon R asked the bigger question: Can adult children, in a respectful way (her emphasis), fill in to mitigate those “deficiencies” that become life changers due to aging?… And cause more problems for everyone?

Clearly we can’t do certain things for aging parents (eg. exercising). But we can educate ourselves (ie. ask their doctors) about products that help (eg. medication reminders) and be their cheerleaders (or have our children be their cheerleaders) when motivation is involved.

Bottom line: We probably do expect too much of aging parents. We all have deficiencies–they may be benign in younger people but life-altering in older people.  Identifying them in aging parents and compensating when possible can help parents age well–or as well as possible.

HELP! Aging Parents was nominated for “Best of the Web” 2012 and was first runner-up in the “blogs by individuals” category. Thanks to everyone who has found HELP! Aging Parents helpful and supported us. 

Cell Phones vs. Alert Pendants if Seniors Should Fall

Help! I’ve Fallen! 

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Are cell phones and alert pendant equally effective in getting help when an older person falls? We had that discussion the other night at dinner with friends. We remembered that 97-year-old Senior Advisor, R, had neither cell phone nor pendant and spent the better part of 3 hours trying to crawl and drag her body about 40 feet to a phone, then figure out how to get the phone down so she could call 911. We agreed: the quicker the response that sends appropriate help, the better.

Facts:

>My “best cell phone for seniors” post has been read well over 34,290 times*–many more times than the two carefully researched posts on Alert Pendants. 
>Falls are a leading cause of mortality and morbidity among adults age 65 and older:” Oregon Research Institute Study 2008
>Every 18 seconds an older adult is in the emergency room because of a fall:” Center for Disease Control and Prevention.
>1 in 3 adults over 65 will fall every year.
>falls cause 300,000 hip fractures a year.

As if confirming the above–two far-away-living friends recently fell and broke their hips. One, an accomplished equestrian just over 65 who still jumps competitively, was rushing to leave home, arms loaded with stuff, and tripped over their old dog who was lying in an unexpected place. The other, an active 71-year-old,  wrote: “I was stopped in my rushing-about tracks when I fell and broke my hip in early June…I am now driving.”

Judging from the # of views plus the comments on my “best cell phones for seniors” post, children and grandchildren see cell phones as especially valuable for older people in emergency situations. But how effective are cell phones (even with the recommended ICE or an emergency button) in getting timely help if someone is alone and falls?

  • Most older people don’t carry cell phones everywhere with them (ie. at home– to the bathroom where many falls take place).
  • A cell phone in a pocket or purse may be unreachable.
  • Older (as well as younger) people can forget to recharge cell phones.
  • If one falls and is unconscious how is help alerted?

While cell phones have wonderful advantages for aging parents and make great gifts, if we want to give older people the most protection if they should fall, the alert pedants’ technology is superior–having none of the problems just listed, assuming one wears the pendant or bracelet. (If Tiffany made alert pendants would people be more inclined to buy–and wear–them?)

When there’s a risk of falling because of age, I–for one–would certainly prefer to know who was orchestrating my rescue (the alert pendant company’s trained responders) as opposed to leaving it to chance.  That said, for the benefit of aging parents and grandparents, check out the two posts featuring “alert pendants.” Older people tend to get them after they’ve fallen or a good friend has fallen and “converts” them….after the horse is out of the barn so to speak. Why wait?

Check out “Newsworthy” (right sidebar). Links to timely tips, information and research from top universities and respected professionals–to help parents age well.

*statistic updated 1/11/13


 

Elderly Broken Hip Summary: Surgery, Rehab, Full Recovery, Now Home Alone–Part 4

R. is home.  She’s using a cane or a walker. Her recovery is due to a variety of factors including the fact that her doctor deemed her health very good for a person her age.

Summary of R’s broken hip and recovery:

1.  Her broken hip (from a fall) involved a broken femur.
2.  Her doctor insisted on a highly experienced orthopedic surgeon who had “good hands” and thus could “get in and out quickly” when putting in the pin. Surgery causes trauma to the body at any age, but more for old people. Less time in the operating room, less blood loss, less anesthesia=less trauma.
3.  R came out of the anesthesia quickly.  The hospital stay went as planned.
4.  First priority when selecting the rehab center: physical therapy team’s reputation. Narrowed to two candidates, the one closest to R’s home was chosen…easier for us to get her daily mail etc.  Maintaining her interest in the world outside herself was important.
5.  Initially she was helpless, confined to lying on her back, needing to adjust to new routines, people, food, problems. (eg. everyone was given Tums to boost calcium. Tums never agreed with her.  Her calcium pills+D needed approval by the rehab center’s doctor which took time.  No big deal, but for someone lying in bed it can become a major deal.)  Frayed nerves, stressed emotions from pain and the surgery.
6.  R quit prescription pain killers once she thought she could handle the pain with an over-the-counter drug.  Didn’t want side effects of unnecessary pain killers.
7.  Surgeon’s orders: no weight-bearing on the side with the broken hip for 90 days.
8.  Physical therapy began immediately with the above restriction.
9.  Being the oldest “rehaber” R learned to inform the young therapists when she knew she’d done enough.  When she didn’t, she would be too sore to have therapy for a day or more, and she didn’t want to lose ground by foregoing a day of therapy. She knew herself–knew when enough was enough for her at 97.
10.  R chose not to eat in the dining room. Older people with bibs or napkins clothes-pinned around their necks to ward off spills was depressing.
11.  Once she could sit in a chair–rather than lying in bed–she alternated with sitting, conscious of moving as much as she could each day.
12.  90 days later, new x-rays showed hip healed.
13. Her therapy changed. Able to bear weight on both legs, she had to learn to walk again.  Things we do–and she’d done–automatically for decades, she had to relearn.
14.  Relearning how to walk, took longer than she anticipated. Some days were discouraging. Suddenly it all began to come together. She was mobile.
15. She’ll stay in her home–no caregiver through choice–with an alert-pendant-necklace (which prior to falling she had refused). This was the one thing we insisted on; she agreed.
16.  Scheduled out-patient physical therapy at the rehab center: twice a week. One of us will drive her.
17.  We try to help parents age well. We’ve offered our help and will help when asked; but R will “call the shots.”

Disclaimer and note: This should not be construed as medical advice. I am a counselor (not a medical person) wanting to share R’s experience so people realize under the best circumstances an elderly person’s broken hip can heal and one can walk again. While this worked for R., it may not work for everyone.

A Cleveland nurse shares, from her “side of the bed,” the elderly broken-hip experience and family involvement from beginning to end. It’s a good companion to this post.

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Aging Parents: Elderly Broken Hip-Full Recovery-Part 3

Attitude+Rehab=97-year-old’s broken hip recovery

Excellent physical therapists play a major part in aging parents’ broken hip recovery success following surgery. But there is considerable initial adjustment.

An aging parent’s broken hip means a lot of down time and takes a lot of patience–especially at first. Little strength is limiting; lying flat on one’s back produces boredom. Pain and the insecurity of what lies ahead can easily lead to grouchiness and depression in the nicest people–until they see progress. Because we’re a culture of instant gratification and short attention spans–or so they say, older parents may have more patience than we, which clearly benefits elderly broken hip recovery.

97-year-old, Senior Advisor R. reports that upon admission to a rehab facility one must make a complete adjustment. One must accept the way things are. “It’s not like a hospital–not like having someone at your beck and call when you ring the call-button,” says R, adding “It’s not real nursing (except for those who must have it).  Asking the hardworking staff for more than one’s entitled to only incurs frustration for both patients and attendants. Realizing this early, helps. Indeed some people make themselves miserable wanting more than the staff can provide.”

R. says she continually reminded herself that she was only there for one reason: the therapy—not full attention from an aide whenever she wanted it. They made it known: “We’re not here to help you, we’re here to help you go home.”

R. laughs when she recalls the first day of therapy: a circle of wheelchairs inhabited by “a bunch stroke victims, fall victims, Parkinson sufferers, mentally disabled–all in physical trouble.”

It helps aging parents to move forward when they understand that some can’t do the exercises at first, but shouldn’t get discouraged. “Our strength is in short supply when we begin,” R observes.  “While a lot of pain at first is discouraging….there are good days and not so good days. But you’ve got to get through it.”

“The Parkinsons woman, for example, had no expression, her head would go down on her chest, she couldn’t follow through, but bit by bit they keep working with her and finally make progress. There’s pain, some exercises are easier, some so hard, some people are doing well, some not so good. When there’s wonderful therapy, bit by bit people get stronger.”

One grown daughter comes for her mother’s sessions.  For some mothers (and fathers) their adult children’s support is encouraging and it doesn’t disrupt the group’s work.

So we help aging parents’ broken hip recovery by finding excellent rehab for them…And then by our presence, our encouragement, our empowering, our running errands as needed…and perhaps by a few prayers.

For a summary of 16 key points in R’s recovery, click: https://helpparentsagewell.com/2011/01/25/elderly-broken-hip-full-recovery-and-going-home-summary.

Check out: “Newsworthy” (right sidebar). Links to timely information and research from top universities, plus some fun stuff–to help parents age well.
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Broken Hip: 97-year-old’s Fall, Surgery, Rehab, Amazing Recovery Chronicled–Part 2

Rehab–Attitude and Reality

A broken hip makes one helpless.  Can’t move, can’t get up and do what you and I take for granted daily.  Excellent doctor, successful surgery, excellent rehab facility selected. Yet as R lay flat on her back in a hospital bed after admission to the rehab center, we realized there would be “down days” and physically-challenging work ahead.

The importance of attitude: loomed front and center.  First concern–whether a proud, successfully independent 97-year-old woman would have the will to endure, and recover from, almost complete dependency accompanied by the pain remaining after surgery and accompanying the physical therapy.

Control and Empowering: We couldn’t control much, but wanted R to feel empowered, not like a helpless little old lady.  She’d never considered herself that way, that would be so undermining. To this end, we immediately requested that the staff call her by her first name, never “honey” or “sweety” (or any other too familiar or what she might consider a diminishing pet name so commonly used in care facilities).

Next, we asked R to give us orders–where to put things, what things she wanted us to bring her from home, what we could do to make the room more user friendly for her etc. etc. That gave her a smidge of control. Within a week, she also tried to control what little she could.  “Pick the dead leaves off that plant, she would instruct.  “I don’t want to look at dead leaves,” she’d emphasize.” “I don’t want clutter in this room,” she’d say. We complied with any “orders”.  Her mind worked, we didn’t question even seemingly unnecessary (to us) “orders.”

Adjustment: The first week in an institutional setting is similar to a child’s going to school for the first time: unfamiliar routines, new people, different food, expectations, and disappointments. When we don’t feel good, we’re weak, we lack energy and we’re not mobile, we may not feel much like adjusting.  We may be cranky or worse.  Understandable, isn’t it? Here’s where focusing on the big picture helps.

What’s the goal? Always keeping the goal in mind applies equally to helping aging parents and their children. This helps ward off the disappointments, insults, and temporary setbacks. The goal in R’s case was to be able to walk again, regain independence and not need a wheelchair. But R had an intermediate goal because of her surgeon’s instructions to the rehab center: “no weight on the left leg for 90 days,” then an x-ray to be certain the hip was healed, before weight-bearing exercises could begin on that leg.

Patience: Unbeknownst to us, until she told us she had passed the 45 day, half-way mark, R was mentally crossing off the days until her return to the surgeon and an x-ray showing the femur had healed…..    To be continued on next post 1/22/11.

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Note: An RN in the family was emphatic that once R began the weight-bearing exercises on the leg with the broken femur, she should never use a wheel chair. Why? Because the unused leg needed every chance to strengthen and using the wheel chair eliminated precious time exercising that leg. Indeed she said using a wheel chair instead of making oneself walk at every opportunity while doing rehab, is a reason old people who break a hip will become confined to a wheel chair, never to walk normally again

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