Mobility-Challenged Aging Parents: From Rehab Center to Home for Thanksgiving at 97

The Ingredients to Make it Happen 

Our Thanksgiving celebration, like that of many, brings together family members and one or two very close friends and their families. We span generations. This year the youngest is 5 months old and  R is 99.

R has never missed our Thanksgiving gatherings be they in the East or in the West. But year before last–on September 30th–she broke her hip. Attending Thanksgiving dinner that year was questionable. After hip surgery for a broken femur, doctor’s orders were no weight bearing on leg for 90 days….and she was in a rehab center.

There were times leading up to Thanksgiving when R didn’t think she could make it; but in her heart of hearts she wanted to come. The rehab center people said if she wanted to come, we all would be trained, keeping in mind she could only put weight on her good leg. Here’s how:

1. The physical therapist worked with R, sitting in her wheel chair with brake set, getting up on her good leg, teaching her to make a small turn using both arms and one leg, holding someone’s hands for stability. She kind of hopped on her good leg and turned on her heel so the back of her leg touched the car door frame on the passenger side. Then she lowered herself onto the car seat (body facing opened door) and with her good leg she moved herself around so she was facing forward and ready to go.

2. The physical therapist and R practiced this particular maneuver for several days preceding Thanksgiving. We watched how she did it. We knew R would have no problem leaving the rehab facility because if she was having problems, there were professionals at the rehab facility to help her into the car.

3. The bigger challenge was our helping her out of the car and into her wheel chair, when we got home, then into the house (with carpeted floor) and over to the dining room table. We debated whether she should/could transfer to a chair once at the table; and ultimately decided not to try–if the wheel chair would go up to the table and fit nicely. It did.

4. My husband and I were instructed how to help R get into, then out of, the car. Two memories are better than one. R remembered very well also. We knew what to do, but our insecurity (which it turns out wasn’t necessary) was being able to do the reverse to take R back to rehab. It was important to take R back before she was too tired to do her part.

Although R was clearly tired from the outing, joining everyone for Thanksgiving dinner was uplifting.  We began taking her out for short drives soon after–always affirming for her. It was a mental boost–a reality– that she was making progress.

Since there are several days until Thanksgiving, R’s experience may be useful right now. And since the percentage of older people who can expect to fall and sustain a broken hip is soberingly high, remembering R’s experience could be important in the future.

Obviously talking with the professionals at the rehab center begins the process, which in R’s case, was a jump-start to getting back to normal.

2/20/13 Help! Aging Parents again was 1st runner-up, this time joined by 3 additional  blogs for this honor. Check them and all finalists out on   http://www.seniorhomes.com/b/2013-best-senior-living-awards/best-senior-living-blogs-individual/  And many thanks again for your vote.

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.

Click Tab Below Header or “Related”  Below For All Broken Hip Recovery Posts

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

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.

*                                *                                *

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

Click Tab Above For All Broken Hip Recovery Posts 

Note: Newsworthy (right sidebar) for current research and information from highly respected sources–to help parents age well.

Broken Hip: 97-year-old’s Fall, Surgery, Rehab, Amazing Recovery Chronicled–Part 1 (of 4)

97-year-old Recovers and Regains Independence After Fall and Broken Hip–Part 1

For everyone fearful of…caring for…or recovering from…a broken hip,  Help! Aging Parents chronicles Senior Advisor R’s fall, her “rescuers,” surgical considerations, rehab highlights and insights, and lastly her preparation for returning home.  She will go home with an alert pendant, a cane, and a walker for going out when anticipating a great deal of walking. No caregiver.

What follows may repeat snip-its from earlier posts.  But the chronology and additional information make it hang together better.  A recap of R’s experience is also a helpful frame of reference for those going through this not-for-sissies/prima-donnas experience.

Part 1: The Fall, the Rescuers (911 and doctors)

R. didn’t have an alert pendant. In late September as she walked from her bedroom to the kitchen, she noticed her twice-a-month cleaning help had moved something on the desk she was passing. She reached around to reposition it, realized she was losing balance, grabbed the nearest chair, but it wasn’t heavy enough to support her weight, and they both fell on the carpet.

R recalls she grabbed at a table leg thinking she’d pull herself up. One side of her body would not move. She knew immediately she couldn’t get up. That ad, “Help, I’ve fallen and I can’t get up,” for the first time resonated, R, said.

The next 3 hours were spent inching her way back 31 feet to the bedroom, and a telephone.  She rolled over on her stomach and with her arms in front “kinda pulled her knees and body along.” Her knees sustained carpet burns, one of which is still not completely healed.

The phone, on a table, was too far to reach from the floor, but there was a waste basket nearby.  R grabbed it, was able to reach up and, after repeated attempts, knocked the phone out of the cradle. “Very hard work,” she says. She phoned a nephew, who drove to her home, called the doctor, got the answering service, who told him to call 911.

Paramedics came immediately. First 2, then more to make certain her condition was stable then to place her on the gurney and transport her to the hospital designated by her primary care doctor (who by this time had been contacted).

Now in the “right” hospital, the next step was the “right” surgeon, for this 97-year-old, with a broken femur. R’s primary care doctor was insistent on one particular orthopedic surgeon who had “technical excellence” and “good hands.”  Why? “Surgery is a trauma to the body. It is not tolerated as well in the elderly as in the young,” according to R’s highly regarded doctor.  “It’s important to get in, get out, do a quick job with less anesthesia, less blood loss, less time in the operating room.  That means less trauma.”

Clearly these early steps cleared the way for R’s ultimate excellent recovery and gave us far-away-living children (one of us was out here almost all the time) confidence that–in terms of helping parents age well–we were on the right track. To be continued on next post 1/18/11.

Help! Aging Parents is again a finalist in  the “Best Senior Living Blogs by Individuals.” Thanks to all who voted. Click 2014 badge at right to see and link to all finalist blogs.