Insufficient treatment of pain may also inhibit recovery. Pain medication should be given so that the patient is able to get adequate sleep and perform the rehabilitation  exercises. Pain medication given before exercises can increase tolerance. Pain levels need to be monitored by family as pain in general is often undertreated in the elderly.

Rehabilitation is a team effort on the part of the staff, the patient, and family. The Physiotherapist designs a rehabilitation or exercise regime. The Occupational Therapist will measure for a walker and help plan for the patient to be able to function at home after discharge.  The Social Worker will be involved in looking into post discharge resources and needs.  These may include a referral to an Occupational Therapist,  Physiotherapist, or for Home Support to help with bathing, or housing if the patient will be unable to return home.

Families should ask the staff as soon as possible after surgery about the fracture, what the  repair consists of, whether  the patient will be weight bearing or not in the beginning, and what the rehabilitation and discharge plan is.

Discharge  timing should depend upon the patient's progress,  help and resources  available at home, and the circumstances of the living arrangement. A person must be able to get about their home, in and out of bed, on and off the toilet, or have help to do so. Equipment that may be needed may include a walker, wheelchair, bath chair, bars in the bathroom and around the toilet, a hospital bed or bedrails, or  transfer aid. Family members should be given a list of the equipment that may be needed, and where it can be rented or bought.

A person may be considered ready for discharge when they attain a certain guideline, such as when they are able to walk twenty steps. A longer recover may entail transfer to a rehabilitation unit, or to what is called a Transitional Care Unit, where actual medical needs are less than in hospital.  

Rehabilitation will continue long after the person is discharged. It may include help from a Physiotherapist and/or Occupational Therapist. Depending on the severity and type of fracture, it can take many months. Goals for rehabilitation include regaining ability to dress, walk,  pick things up, cook, and carry things.  Discharge should include a rehabilitation plan that will help to insure progress continues.

For more information on hip fractures, click here.

The major cause of hip fractures in older people is falls. Click here for our article on falls prevention.

When 80 year old  Parvita  broke her hip, her son Raj called us for advocacy and guidance when interacting with the hospital.  Parvita's family was very close, her son lived in the same home, and three adult children who lived out of town were in contact weekly by  phone.  It was frightening for  Raj and his siblings to see what happened to their mother-- a healthy, active, and vibrant woman whom they now realized was getting old.   The adult children had a conference call and made plans on how to help. They  discussed  changes in the home which would have to be made, who would come up to stay  with her, and who would do the daily chores.

Parvita's children's reaction is typical of a family in crisis when they realize for the first time what it means for  their parent to be getting older.  There was a lot of fear and anxiety and confusion.  There was also a tendency to take over decisions from their mother.  We reminded them that their mother would still be an adult: alert and able to make her own decisions. We suggested the family include her in decision-making.  What does she want to have happen in her home?  What kind of help does she want, and how does she want to get it?  We also talked to Raj about how he and his siblings can handle their own fears and sadness, what is actually a form of what is called anticipatory grief.  Handling these feelings appropriately  enabled them to deal with their mother in a way that was respectful of her.

Diamond Geriatrics helped Raj by taking him, step by step, through much of the information and processes described in the article above. Understanding what was going on, why, and what the options were was very helpful to him and his family. They helped Raj to be more active in discharge planning. He knew who to contact, and  what to ask them about. Having the opportunity to talk with the staff helped to lower the whole family's  anxiety and made them feel less helpless.