Thursday, July 26, 2007

Broken hips in the elderly can lead to death

Yesterday, I posted a link to a story about hip protectors not reducing the number of broken hips among seniors in nursing homes. According to the National Center for Health Statistics; Centers for Disease Control and Prevention; 2003 National Hospital Discharge Survey, there were about 345,000 hospitalizations of elderly men and women in the US during 2003. Statistics show that only 1 of 4 patients recovers completely and nearly 1 in 4 will die within a year of the fracture because of complications.

Broken hips among the elderly is a serious problem. What makes it such a problem is not the broken hip itself, but all the issues that surround it.

Picture this: a healthy 75-year-old, walks daily, is fully independent at home and is happy with her life. She visits her grandchildren and volunteers in her community. One morning, she slips on the stairs, falls, and breaks her hip. She’s brought to the emergency, where she waits to be seen. The doctors admit her so they can operate and replace the broken part.

While waiting, she can’t move, she can’t go to the bathroom without help. Her pain level is sky-high. So, this previously active woman is now lying in bed, completely dependent on others to help her.

She has her surgery and works on recovery. However, her bedrest has led to pneumonia (How Can You Die from Pneumonia?), or because she couldn’t urinate in a bedpan, she was catheterized and may develop a urinary tract infection.

She has little appetite because she isn’t moving around, has pain, there’s no-one to help her, and/or doesn’t like the food. The lack of appetite makes her lose weight and get weaker.

She could develop confusion from the pain, the different medications she’s given, or an infection. The hip may not heal, causing further problems. And the list goes on.

While these scenarios are all maybes and perhaps, they happen and they happen often. To the point that this once healthy, active person is now dependent on others and may not be able to live alone again. According to the American Geriatrics Society Foundation for Health in Aging, for seniors the risk of death in the year following a hip fracture is as high as 20% to 25%. The rate varies depending on the person’s sex, age, race, physical condition, and previous medical history.

Women are more prone to breaking a hip, 2 to 3 times more often than men. Hip fracture rate doubles every 5 years or so after the age of 50 years. The American Academy of Orthopaedic Surgeons reports that white, post-menopausal women have a 1 in 7 chance of fracturing a hip, and that almost half of women who react the age of 90 years fractured a hip.

What can be done to protect our seniors? Prevention is pretty well the only thing that will help. Wherever an older person lives, the environment has to be as fall-proof as possible.

While falling from dizziness or illness happens, most falls happen as accidents. The American Association of Orthopaedic Surgeons offers this page with many tips for seniors to reduce their risk of falls. Some tips include not getting out of bed as soon as they wake up, but to sit on the side of the bed and wait for a moment to make sure their blood pressure doesn’t drop and don’t leave clothes or newspapers on the floor.

I often add other tips such as, no scatter rugs – they are dangerous for slipping. Make sure all electrical cords are tucked away and not where they can be a cause of a trip. If there are runners on the stairs, make sure they’re fastened down well. And, make sure that slippers or shoes have good tread and grip on the floor to prevent slipping.

Since women with osteoporosis have a higher chance of breaking a hip, getting regular check ups, taking medications if prescribed, doing weight-bearing exercises, all help prevent bone mass loss, reducing the risk of a hip fracture.

As the population ages, more hips are going to break. We need to be vigilant and try to prevent as many of them as possible.


Dawn said...

I spent some time caring for an elderly woman and know exactly what you're talking about. She was independant for her age until she was forced into hospital for a month and when she returned to her own home, she could no longer cope. She was never able to regain the mobility that she lost whilst in hospital.

Marijke Vroomen-Durning said...

Hi Dawn,
It's frightening how fast they can go downhill after being ill or having an injury. So sad.

Anonymous said...

Hey, I visit my grandmother every day in the hospital and now in her nursing home. What you have described is exactly to the T my grandmothers experience after breaking her hip. My father is now building an assisted living home with a rehabilitation center. Keep writing these articles, they are such an eye opener to not only caregivers but to people building up businesses in the elderly industry. Thank You.

Unknown said...

My mother is 86 and in the hospital recovering from partial hip replacement yesterday. She is diabetic, and up until now, very active. What are some things to watch for during the healing process?

Marijke Vroomen-Durning said...

Hi Lisa,

Great question because being vigilant can really make a big difference in outcome.

I can only make some suggestions what I would do in a very general fashion.

1- Make sure your mother takes her pain medications. A big issue is older people resisting their pain meds thinking that they can manage. the problem is, if she is having pain, she'll be less likely to move around like she needs to be.

2- Encourage good nutrition. Your mom may not have much of an appetite, so it's important that what she does eat and drink is healthy. Try getting her to eat small amounts several times a day instead of three big meals a day; of course, because of her diabetes, you should speak with a dietician to be sure that this would be a good move for your mother.

3- Watch her wound's healing. Many people with diabetes are slower to heal so keep an eye on the wound. if it starts to look red, swollen or feels warm, get it looked at asap, to make sure there's no infection.

4- When getting your mother to move around, be sure she has lots of support in case she becomes weak all of a sudden or trips. You don't want her to fall.

5- As she is likely going to be spending more time sitting and lying down, have her skin checked regularly to be sure she doesn't get any pressure sores. If you find an area that remains red after the pressure has been removed, it's important that this spot not get any more pressure so the skin can heal. This is how pressure sores start.

If you can keep your mom eating and drinking well, taking her medications and moving about, you're really doing a lot to help her.

Good luck!

Unknown said...

Thanks for your response. Eating is already a problem and the next thing I fear is depression. Mom has been very active and usually walks to a local mall (a little over a mile) once a week, among her many other activities. I have 5 brothers and sisters and we are going to do all we can to keep her spirits up.

Anonymous said...

Since Feb of this year My husband and myself have been staying with my Mom. It all started with finding out she had colon cancer 4 treatments of chemo was all she could do. Then she fell the first of NOV. and broke her Hip.We took her to the ER and they found nothing wrong she kept getting worse so i called her dr. the did the same thing the er did and found her hip was broken.Now she can not walk or do anything for her self.This is so frightening to me just 8 months ago my Mom was doing everything for her self.
Susan kinston NC

Anonymous said...

My mother-in-law has severe dementia and broke her hip two months ago. She is undergoing physical therapy. Progress is very slow. She is able to take a few steps with assistance from the pt.She is in memory care at an assisted living facility. How long should she continue with therapy. Does there come a point when it's not feasible to continue.

Anonymous said...

I have "protected" my mom for ten years, four which have been in a convalscent hospital. Everynight I would go and prepare her for bed and put the bed rails up to protect her from falling. The facility was "dinged" by the State Medical Inspectors for putting up the rails stating that it was a restraint! One night I found the rails bolted in the upright position! Vowing to do something about it the next was too late as she fell out of bed and broke her hip. At 92...not looking for miracles. A totally preventable accident. I am looking into it...but wanted people to be aware of this "law"

Lin said...

Our mother is 89 years old in March. She has severe Alzheimer's and cardiac dementia. Three weeks ago she was pushed by a lady in the home she was in and fell and broke her hip. It took them a week to figure this out and then three days to wean her from Coumadin..before they could operate. They had to replace her hip..mainly for pain control and now what little mind she had left is is like all of this has pushed her over the edge. She doesn't know us anymore..she had some difficulties before the trauma happened, but now we don't think she will be able to mentally or physically come back from this. What can we expect in the future? My concern is Hugh for her...Thank you...LIN

Marijke Vroomen-Durning said...

Hi lin, I'm sorry to hear about your mom. Unfortunately, I can't really tell you anything as I don't know your mom and I don't have her records. Anything I would say would just be a guess and that would be dangerous.

I do hope that things go well.

Anonymous said...

Hi Im a aide for a 88 year young lady and my heart hurts every day, she broke her left hip at home on a Thursday. Morning had surgery. On Friday
Went to rehabe on Monday. We put a bed alarm on her just in case because of the short rail's. But she had to go to the bathroom she said nobody. Cam to help her and she got up with the arlarm ringing. And broke the right hip so this 88 year young lady now has 2 broken. hips Is their a God! !! Please if u have a mother or father in one of those places try to get everybody u can to take shifs of 2 or 3 hours because their NOT looking after your family menbers!!!¡!!