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JoyMC
08-14-2011, 12:39 AM
i have a character in her mid-seventies taking a terrible fall and breaking her hip. perhaps in several places.

can anyone talk to me about the recovery? how long would she be in the hospital? how long would she have physical therapy after she gets out? will she be in a wheelchair? on a lot of pain meds?

thanks!

justkay
08-14-2011, 06:01 AM
Yes to all of the above and it depends greatly on the person's health and mobility at the time of the fall.

You can expect a four to six week recovery period in a long term care facility. Bending is out of the question during this period.

If the MC is overweight or has limited mobility to begin with they probably will never fully recover, living out the rest of their life in a wheelchair.

Also there's the issue of mental clarity. There's a lot of pain medication involved, which can be hard on anybody at any age, but can more severely affect the elderly. This will slow down their rate of physical therapy and how much actual walking they are allowed to do. For example, a young person would be given a walker and encouraged to walk the halls, but an older person will need an escort.

I can tell you this for certain, breaking a hip over the age of 65 is a virtual death sentence. Best case scenario, the patient manages to get around with a walker - most will end up in wheelchairs permantly.

Statistically speaking, most of the elderly die within a year and a half of breaking a hip. That's what my mother's doctor told me and she died eight months later, having never left that long term care facility.

Canotila
08-14-2011, 06:01 AM
It depends on her physical condition before the fall. If she was barely doddering along beforehand, with poor muscle tone, etc. then it's likely it would cripple her for the rest of her life. When I worked in a nursing home, many of our residents were sent there during PT after falling and breaking a hip. Many of them never went home. Many of them never got out of the wheelchair.

The one lady I took care of that did recover was very active and independent before she fell. She was stubborn. And she was determined to go home. She actually had really good muscle tone and a very sturdy build, which were both major pluses for her. The doctors kept saying she'd never be able to walk again. She walked three months after coming in and refused a wheelchair after that. A month after that she refused the walker. It was terrifying because she still didn't have the greatest balance, but I had a lot of respect for her tenacity. She did end up finally going home after 6 months in the nursing home doing physical therapy.

I'd try and avoid the multiple breaks scenario if you want your lady to be able to recover. Something like that might likely require surgery, depending on how much bone she has left in her hip. And even if she did get home, she'd likely never be fully recovered.

dreamcatcher
08-14-2011, 06:17 AM
Yeah, my grandmother broke her thigh and she permanently needs a walker or wheelchair. She's gradually going downhill. And she's in her 70's.

She wasn't very fit to begin with though.

jclarkdawe
08-14-2011, 07:04 AM
What does your story need? Depending upon your original health and how the hip broke will impact this. Did the break occur because of bone loss density, or a fall? My mother was up and walking within a couple of days while a neighbor died with two weeks of breaking his.

Most people are going to need extensive rehab, be stuck in a wheelchair or walker, and not survive for long. Because of the patient's age and physical condition, rehab can't be very extensive at any one time. (Old people tire quickly.)

Hospitalization isn't that long. Rehab, on the other hand, frequently lasts longer than Medicare's 100 days. Pain meds depend on the patient and can be anything from tylenol to the good stuff that excites the DEA.

If the hip is shattered (comminuted fracture), you're going to need a hip rebuild which is a long operation, a long time in the hospital, and incredibly hard even for a young person to recover from. However a comminuted fracture of the hip can occur in such a way that the hip is rather stable, with minimal problems.

Best of luck,

Jim Clark-Dawe

waylander
08-14-2011, 03:47 PM
The general anaesthetic required for the repair op can also cause significant mental detioration.

Maryn
08-14-2011, 09:42 PM
When my mother-in-law broke her hip, she was already in a nursing home for dementia. We were surprised to learn that once the surgery was complete, she went directly from recovery room back to the nursing home, where she was not in bed but in her wheelchair as usual. Though presumably she was medicated for pain (since she didn't seem to be experiencing any), she was no worse off mentally than before her spectacular eight-inch fall.

(The moral of the story is drink milk, young women!)

Maryn, all about strong bones and healthy teeth

JoyMC
08-14-2011, 10:19 PM
thanks so much, everyone! very helpful, all of it.

my story has a (healthy, active) grandmother as the guardian of her 12 year old granddaughter. she falls off a set piece in a community theatre production, and i need her to need to move into an assisted living facility (or something similar) and not be able to care for her granddaughter anymore. but i don't want her to die soon.

so it sounds like making sure she's emphasized as strong and healthy to begin with, maybe making her late 60's instead of mid-70's, a simple break, but she would at her age still probably need additional care for months. i do have her in surgery, but could take that out if it makes more sense for a simple break that isn't going to kill her.

it's middle grade, so i'm not getting into a ton of details about the medical situation, but i need to get right the basics of how long she's in the hospital and where she can live afterwards. (they live in a 3-level townhouse.)

thanks so much!

wheelwriter
08-14-2011, 11:06 PM
thanks so much, everyone! very helpful, all of it.

my story has a (healthy, active) grandmother as the guardian of her 12 year old granddaughter. she falls off a set piece in a community theatre production, and i need her to need to move into an assisted living facility (or something similar) and not be able to care for her granddaughter anymore. but i don't want her to die soon.

so it sounds like making sure she's emphasized as strong and healthy to begin with, maybe making her late 60's instead of mid-70's, a simple break, but she would at her age still probably need additional care for months. i do have her in surgery, but could take that out if it makes more sense for a simple break that isn't going to kill her.

it's middle grade, so i'm not getting into a ton of details about the medical situation, but i need to get right the basics of how long she's in the hospital and where she can live afterwards. (they live in a 3-level townhouse.)

thanks so much!

These days, she'd only be in the hospital for a few days - at least three overnights so she could access her skilled rehab benefit. She'd most likely go to a skilled rehab center, which is usually attached to a nursing home but is its own section. She'd get almost daily PT and OT. If she was active and youngish (late sixties, early seventies), I don't think there would be a reason she couldn't return home and continue to live a pretty active life. If she's older and has multiple other medical issues, or she wasn't previously active, then it would be a more life-changing event. She would probably be in the skilled nursing home for somewhere between three weeks and three months, depending on her recovery, family support, and supplemental insurance. She could return home and have VNA provide additional therapy. A person who is healthy and independent, and in their late sixties, feels too well to sign themselves in to an assisted living facility.

I just did a quick Google search to make sure my own experience isn't totally off base. It showed the average age of someone in assisted living to be around 85.

GeorgeK
08-14-2011, 11:34 PM
You can expect a four to six week recovery period in a long term care facility. Bending is out of the question during this period..

And if they aren't walking by 6 weeks, they probably never will again.

There are some truly staggering statistics having to do with fractured hips

cameron_chapman
08-15-2011, 03:33 AM
I can tell you this for certain, breaking a hip over the age of 65 is a virtual death sentence. Best case scenario, the patient manages to get around with a walker - most will end up in wheelchairs permantly.

I have to wonder about the accuracy of this. My grandmother broke her hip when she was 88 years old. She had to have a hip replacement, spent about 6-8 weeks in a rehab facility (with physical therapy and occupational therapy to make sure she could perform basic tasks around her house), and then went back home, where she lived alone. A few months later she fell again, and at that point it was decided that she shouldn't live alone anymore (after she refused home health care).

She lives in an assisted living facility, but it's the lowest-level type of care available (basically, they do meals and cleaning, sit in the bathroom with her while she showers, etc., but no nursing care). She'll be 92 in December. She gets around with a walker, and she has pretty bad memory issues because of the anesthesia with the surgery (short-term memory is crap most days, but long-term memory is fine). For 92, she's doing well.

I have an aunt who broke her hip around the time she was 80 (I think she's in her mid-late 80s now). She did fine for quite a while afterward. She uses a walker now, and she's gotten pretty frail, but for a couple years after she broke her hip she didn't really have any problems.

I think mobility is definitely an issue for elderly people who break a major bone (though I've never known anyone who ended up confined to a wheelchair, most were either forced to use a cane or walker), but I don't think it's a "virtual death sentence" by any means. That might have been the case 20-30+ years ago, but I don't think it is anymore.

Nugus
08-15-2011, 03:50 AM
I work in a hospital for the elderly and so we see alot of post hip fractures. Whilst it is true that anybody over the age of eighty have a greater risk of fatty embolus or large haemorrhage following a fracture, which can lead to death, it is usually concurrent medical issues that are the problem. If someone fairly young (in their seventies) breaks their hip then they would usually get back to at least 90% of what they were before. But it's very individual. Some people need a hemi-arthroplasty, which is a total hip replacement, and others may only need a dynamic hip screw for a clean break. However the risks of the anaesthetic are the same and the post-surgical risks are also the same.
If you want your character to need assisted living then she will have to have suffered complications post surgery or a concurrent medical complaint may have been exacerbated due to the accident.

GeorgeK
08-15-2011, 04:31 PM
I have to wonder about the accuracy of this. My grandmother .

There is a reason that numbers under 20 qualify them as statistically insignificant.

Your grandmother threw the curve.