A 93-year-old woman breaks her hip...

LJD

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Takes place in Toronto, present day.

This is what I currently have:
93-year-old woman lives in her own home and is in reasonably good shape for her age, though she uses a cane. The woman falls on the stairs in her house and breaks her hip. She's not wearing her emergency alert bracelet and can't get to the phone. Her granddaughter (who lives with her) finds her an hour later and she is rushed to the hospital. They do an X-ray, she has surgery the next day, and stays in hospital about a week. Afterward, she moves in with her son (whose house is much more accessible than her own) and has regular physical therapy.

I just want to check...does that all sound reasonable? She is quite old, but my understanding is that outcomes are not great without an operation (though maybe that depends on the type of hip fracture), so I assume she would have surgery despite her age since she's in decent health. I don't know whether it would be a hip replacement or internal fixation (again, depends on type of fracture, perhaps?) though the details aren't really important for the story, but if anyone could give me any insight here, that would be great. I read that outcomes are best if the surgery is performed within 48-hours, but is it reasonable that it would be done the next day? And is a week-long hospital stay reasonable?

Thanks!

ETA: If she has surgery in the morning, I assume she will be okay to take visitors later that day, though she might be a bit dopey due to anesthesia?
 
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VeryBigBeard

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What you have sounds almost exactly like my experience with this kind of thing (also Canada, not Toronto), except swap not finding out for an hour to finding out and waiting an hour for the ambulance to show up.

I don't remember exactly when surgery occurred--my hazy memory is saying it was that night, in the hospital, but my guess is that would depend heavily on surgeon availability. So if you've got a full ER, I'd guess there'd be a wait.

Visitors would be fine the next day, but for someone that age the trauma--pain, rushing to hospital, surgery--can take a significant mental toll, more so than anesthetic. So it would depend a lot on your character's personality and any issues with dementia, Alzheimer's, etc.

Hope this helps.
 

mrsmig

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Have you been talking to my mom, LJD? Because seriously, this sounds like what she went through about five years back, although there was no convincing her afterward to move in with one of us kids or into assisted living. (She lives in Tennessee, FWIW.)

She had already had both hips replaced, and about six months after the second procedure, she tripped over an uneven curb, fell and fractured one hip. She was taken to the hospital and if I recall correctly, operated on the next day. Because of her age (and also because none of us were able to get extended time to stay with her right away), she stayed in a rehab facility for some weeks and hated every minute of it.

She just celebrated her 97th birthday. She still lives alone although we were able to convince her to give up driving about three years ago, after she rear-ended someone. She uses a car service now to run errands and such. She gets frailer by the month but her spirit is still indomitable.
 
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Jan74

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The only thing I might question is her staying in hospital for a week, if the surgery went well they will discharge from hospital asap. Most knee's and hips are done in day surgery and go to home care nursing for dressing changes and staple removal. I'm in Ontario and I work in home care and usually lengthy hospital stays are only for those who are having complications. Generally speaking, hip surgeries go very smoothly with minimal pain compared to knee's and shoulders. But if she has to stay in hospital for a week I think the average reader will believe it.
 

LJD

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The only thing I might question is her staying in hospital for a week, if the surgery went well they will discharge from hospital asap. Most knee's and hips are done in day surgery and go to home care nursing for dressing changes and staple removal. I'm in Ontario and I work in home care and usually lengthy hospital stays are only for those who are having complications. Generally speaking, hip surgeries go very smoothly with minimal pain compared to knee's and shoulders. But if she has to stay in hospital for a week I think the average reader will believe it.

I thought it might be longer because she's old...but would 3-4 days post surgery be reasonable? (The way the story is, she needs to be in hospital for at least a few days, though it doesn't need to be a week.)
 

Marissa D

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At that age, I expect she's more likely to be sent to a rehab facility post-hospital for some weeks rather than going home, unless she can afford home health aides. There are usually a lot of concerns about things like pneumonia setting in, and that's part of what the rehab care is there to watch for/prevent.
 

cornflake

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At that age, I expect she's more likely to be sent to a rehab facility post-hospital for some weeks rather than going home, unless she can afford home health aides. There are usually a lot of concerns about things like pneumonia setting in, and that's part of what the rehab care is there to watch for/prevent.

This -- I'd send her to a rehab facility for a couple weeks. It's very hard for a family to manage someone who is a falling danger like that and who would likely be less mobile and with less ability to do basic self care like bathroom stuff than a younger person who had a similar surgery as soon. Also very hard to get them to pt and back (and with a hip they probably need to go to a pt place at first, someplace with bars to hold to help walk, maybe a pool, devices to assist with mobility, etc.
 

MaeZe

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The only thing I might question is her staying in hospital for a week, if the surgery went well they will discharge from hospital asap. Most knee's and hips are done in day surgery and go to home care nursing for dressing changes and staple removal. I'm in Ontario and I work in home care and usually lengthy hospital stays are only for those who are having complications. Generally speaking, hip surgeries go very smoothly with minimal pain compared to knee's and shoulders. But if she has to stay in hospital for a week I think the average reader will believe it.
Yes.

In the US, a three-day stay is typical for a hip fracture repair, even with an elderly person. If you need a lot of physical help you would go to a transitional care unit at that time if you are in the US. But if a person were relatively independent before the fracture, as long as they didn't have any trouble walking with a walker by day three, and they were returning to a home where some assistance was available, they would not need transitional care.

A person not so independent, who could not get up and be mobile by day three, then you might be looking at transitional care ending up in a nursing home. But that is less common these days.
 

MaeZe

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At that age, I expect she's more likely to be sent to a rehab facility post-hospital for some weeks rather than going home, unless she can afford home health aides. There are usually a lot of concerns about things like pneumonia setting in, and that's part of what the rehab care is there to watch for/prevent.
Pneumonia sets in when a person becomes immobile. It's not so much of a risk if the person is mobile.

We make a great effort to get all surgical patients up and walking right away unless the surgery requires the person stay in bed. Open heart surgery patients get up the day after surgery. If they can't walk we at least try to get them to sit on the side of the bed or get in a chair.

For an elderly person with a hip repair, it really depends on their weight (obesity is a hinderance to walking), and their previous health and mobility before the hip fracture. Age is not the whole picture.
 

LJD

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Pneumonia sets in when a person becomes immobile. It's not so much of a risk if the person is mobile.

We make a great effort to get all surgical patients up and walking right away unless the surgery requires the person stay in bed. Open heart surgery patients get up the day after surgery. If they can't walk we at least try to get them to sit on the side of the bed or get in a chair.

For an elderly person with a hip repair, it really depends on their weight (obesity is a hinderance to walking), and their previous health and mobility before the hip fracture. Age is not the whole picture.

thanks.

So it would be reasonable to have her walking a little (with assistance) the following day? Or at least standing? She was reasonably mobile beforehand and not overweight. Would she only be walking at the hospital when a nurse (or someone else) was present?

It's best for me if I have her stay maybe 4 days in hospital, then go to stay with her son--she can have a support worker come regularly at the beginning if necessary (probably not relevant enough to story for me to mention it.)
 

MaeZe

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thanks.

So it would be reasonable to have her walking a little (with assistance) the following day? Or at least standing?
Absolutely.

She was reasonably mobile beforehand and not overweight. Would she only be walking at the hospital when a nurse (or someone else) was present?
Always with assistance those first 3 days in the hospital. Keep in mind though, patients rarely get themselves up without the nurses coming in to tell them to. Patients are usually surprised we get them moving so soon.

It's best for me if I have her stay maybe 4 days in hospital, then go to stay with her son--she can have a support worker come regularly at the beginning if necessary (probably not relevant enough to story for me to mention it.)
I don't know Canadian hospital procedures but it sounds good to me. In the US, it's the health insurance industry that pressures the hospital to move patients out ASAP.
 
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blacbird

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A lot of secondary, but very serious, complications can come about afterward from an injury like this. One of my dearest friends broke a leg falling in a bath tub five years ago, at age 71. In hospital a few days later, he died from a coronary embolism related to the original injury. So you have a lot of options.

caw
 

P.K. Torrens

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A lot of secondary, but very serious, complications can come about afterward from an injury like this. One of my dearest friends broke a leg falling in a bath tub five years ago, at age 71. In hospital a few days later, he died from a coronary embolism related to the original injury. So you have a lot of options.

caw

You mean pulmonary embolism, eh?

Yeah - the elderly, unfortunately, can go downhill after a hip/leg fracture. It’s called cascading. Hip fracture -> immobility -> pneumonia -> sepsis -> further immobility -> pulmonary embolus etc.

If it’s a hip fracture, a pretty standard operation is the placement of a DHS (dynamic hip screw). Docs wouldn’t call it internal fixation but it’s a similar principle.
 

WeaselFire

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From experience:

3 days in the hospital, therapy beginning day following surgery. Then rehab for 4-6 weeks, until she is mobile in a walker. Then home, or a caretaker's home, with home nursing and care for another 4-8 weeks. That's if she survives the surgery or the rehab, which is, sadly, not the usual result for someone of that age.

Jeff
 

aruna

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I used to work on the orthopedic ward of a German hospital, managing the after-care of mostly geriatric patients, organising their rehab etc. This would be a femur fracture and in Germany she'd stay in hospital for about 10 days followed by a special 3-4 week rehab specifically for geriatric patients, then some kind of home care. Your scenario sounds fine for North America, where I think hospital stays are shorter.
 
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Twick

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My mother fell and broke her hip (apparently more of a "crack" than a full break). After I was able to get her help by phone (lived in a different province - ack!), she was taken to hospital and surgery performed within about 18 hours. She was kept in hospital about a week, but then sent to a rehabilitation home for several more weeks to recover. If she'd had people to look after her 24 hours a day at home, that might not have been necessary for as long, but she did receive physical therapy to restore her muscle tone.

They sent a woman from social services to inspect the home for safety before she was allowed to return. Loose rugs and furniture you could trip over had to be removed.

Mom told me about how she was frozen but not knocked out for the surgery, and was rather annoyed at the grinding noise as they worked on the bone. She hated the rehab home, because she had to share her room with people who snored quite loudly.

Yes, they did make a BIG thing about getting her on her feet as soon as possible (next day or so).