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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Rehab, Respite, Short-Term Care, Hospitals=Loss of Control

Why Rational, Agreeable Aging Parents Can Turn Grumpy:
4 Insights

My dad was extraordinarily independent.  I knew that; but I didn’t know how much he valued his independence until a respite weekend–just three nights and two days– at “the home” was suggested.

My brother (who lived with our father) wanted to go to the beach for the weekend. There was help during the days to cook lunch and dinner and clean up; my brother was there at night and it worked fine.

Dad, a relatively healthy 90-something-year-old at the time, every week visited old friends at “the home” who lived in independent or assisted living.  So you can imagine my brother’s surprise when Dad vehemently rejected the idea, with a never-before-seen emotional outbreak that stunned my brother.
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R is still living at the rehab center, as you know.  No option initially.  She needed to recover and move forward after surgery on her broken hip.  This is her 47th day there; 97-year-old bones don’t recover as fast as younger bones and she accepts this fact.

Looking back over R’s adjustment, I believe I understand my Dad’s emotional refusal and my mother-in-law’s initial feelings.  Thus I want to share insights that are no doubt common for aging parents who value their independence and probably for most older people in general.

  • Older people take pride in being independent.  It sets them above the stereotype.  It raises self-esteem and confirms capability.
  • Older people don’t welcome change; they’re usually more comfortable and confident in known surroundings.
  • When they must go to an institutional structure (unfamiliar routines and rules) they must adapt, which isn’t always easy.
  • Think: putting your child in kindergarten the first day.  New people, new expectations, and to be successful adapting to the regimen and beginning to make new friends.

Loss of control is scary.  Normally pleasant people can become grumpy and demanding, if not depressed.  Needing to navigate new turf with new ground rules can prove daunting, especially when older people feel helpless and are dependent. As they gain and feel more control (know the nurses, adapt to the routine, understand that it isn’t going to be like home) things do improve. Needless to say, optimistic support from adult children at these times is invaluable. also highlights aging parents’ feelings of control/loss of control and their impact on caring children.