A fractured hip is a life changing and frightening event for many seniors and their family members. This article is meant to help you understand what happens during hospitalization, the rehabilitation process, and to find the support and information you may need.
The terms fractured hip and broken hip are interchangeable.Types of fracture include a femoral neck fracture in which a break occurs where the “ball” (femoral head) that fits into the”socket” of the hip bone, is broken off of the upper part(neck), of the leg bone( femur). An intertrochanteric fracture is a fracture just below the neck of the femur.
The type of break that occurs is one of the factors that dictates the kind of repair that will be done and a person’s rehabilitation potential. Others are the age and fragility of the patient, their mobility before the fracture, and the amount of displacement (where the bone has been moved out of its original position) that occurred in the break. Hip fracture repair is generally, but not always, surgery. Surgery may be a partial hip replacement or a procedure in which pins, or a metal plate and pins, or a rod are inserted into the bone.
Rehabilitation usually starts as soon after surgery as possible, often the next day. The first step is to assist the patient to sit up in bed and to let the legs hang down, next to be helped to get out of bed, to stand up and to move to a chair. This will be followed by slowly building up the ability to walk, at first just one or two steps at a time, with the distance gradually increasing. Whether a fracture repair is weight bearing or non- weight bearing will impact on how and when the patient will be able to transfer themselves in and out of bed, and on and off a toilet and chair. With a non weight bearing repair a person is not able to put any weight on the leg for up to six weeks.
Family members may note their relative is confused after surgery. This can be the result of the pain medications or it could be the result of the anesthesia. On occasion confusion continues.
Rehabilitation can be affected by the patient’s emotional response to the fracture or a fall that caused it. They may have a fear of walking because they do not want to fall again. Some people go into a depression. Families should pay attention to the fear, but also offer support and encouragement.
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.
Families and Hip Fractures: An Example
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.
