Dementia, Broken Bone, and Hospitalization

What to Do When Someone With Dementia Is Hospitalized for a Broken Bone
Doctor and Paitent
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If your loved one with dementia must be hospitalized for a broken bone -- a common aftermath of an accidental fall -- make sure the treatment (and you) focus on three important issues.

1. Advocate for proper pain management

Most people hospitalized for a broken bone will have pain. For some, the pain is present all the time. For others, it's just with certain movements, such as standing.

For people with dementia, the trouble is that they often have difficulty communicating pain. They may not remember the pain when hospital staff come to ask about it. Or they may consistently deny being in pain, even though careful observation of their activity and facial expressions tells another story.

It's essential that your loved one be treated for pain, because untreated pain can cause delirium and also affect his or her ability to participate in the physical therapy that's needed for recovery. Studies show that elderly patients with broken bones are commonly undertreated for pain, especially if they have dementia.

Pain: What you can do

To ensure that your loved one with dementia gets properly treated for pain, take the following steps:

  • If your loved one denies being in pain, watch for other telltale signs, such as grimacing, refusing to move, or being more confused than usual.

  • Let the hospital staff know if your loved one often seems to be in pain. You know him or her better than they do and can observe your loved one over longer periods than any staffer can.

  • If a pain medication has been prescribed on an as-needed basis, you may find it helpful to remind hospital staff to give it to your loved one or talk to the doctor about making the order effective at regular intervals.

2 more important issues for someone with dementia who's hospitalized for a bone fracture

2. Understand what kind of physical activities are OK.

Once your loved one's fracture has been assessed -- and surgically treated if need be -- he or she will be ready to begin the healing and recovery process. People with dementia, however, often can't remember whatever instructions or restrictions have been specified by the doctors and physical therapists.

That's problematic because participating in rehab is essential in order to recover function and regain as much independence as possible.

Rehab: What you can do

  • Make sure the physical therapists understand that your loved one has dementia. Don't count on them seeing it in the person's file. It will help if you can specify the stage of dementia and give some examples of what your loved one is usually able to remember.

  • Make sure you understand the plan for recovery from the fracture, including what kind of activities or weight-bearing movements are OK and which should be avoided.

  • If your loved one can't remember instructions, plan what you'll need to provide help. For example, some people with dementia respond to written signs. Or your loved one may need a caregiver at the bedside most of the time to give verbal reminders. Ask the physical therapy staff to help you brainstorm.

  • Ask about timing pain medication before therapy. Activity can create added pain even though it's necessary, and if this pain isn't inadequately treated, your loved one might not participate in physical therapy. If he or she is balking or not trying hard, talk to the hospital staff about providing more pain medicine, ideally an hour prior to therapy.

3. Request an evaluation for osteoporosis.

In an older adult, breaking a bone may be a sign that the bones are much thinner than normal, a condition known as osteoporosis. It's especially important to identify and treat osteoporosis in older adults with fractures. Treatment can reduce the chance of a future fracture by 50 percent, and it's usually tolerated by people with dementia.

Osteoporosis: What you can do

  • If it hasn't been mentioned to you, ask the doctors to evaluate your loved one -- female or male -- for osteoporosis. Note that men with osteoporosis should also be checked for low testosterone, which can cause osteoporosis.

  • If osteoporosis is diagnosed, ask about a multifocused treatment. Ideally, your loved one should be prescribed both calcium and vitamin D supplements, as well as prescription medications for osteoporosis.

Dr. Leslie Kernisan

Leslie Kernisan is a clinical instructor in the University of California, San Francisco, Division of Geriatrics, and maintains a popular blog and podcast at BetterHealthWhileAging. See full bio

almost 5 years, said...

My Dad just broke his hip. We have been through this and you really need to make sure they are not in pain. We requested he be given his pain meds at first every 4 hours and eventually we got him on a lower dose and he has improved with his physical therapy. The thing about someone with alzheimer's is once they are moved to the facility, hospital, etc. it causes a whole lot of confusion. It is better if a family member can be there at all times also to help with participation with the physical therapy. Most usually they don't even remember what has happened to them. He has been in the hospital for 14 days and still doesn't understand he broke his hip.

over 5 years, said...

I didn't think to have pain meds given on a reg time frame in stead of asking the patient if he is in pain. thank you

over 6 years, said...

Mom fell and broke her hip, it was replaced and then she was sent to rehab. She is getting therapy and 3 meals a day plus snacks, is kept clean and cool in this heat, has folks to talk to but is not bored and scared and says I WANT TO GO HOME, she lives alone, THEN SHE SAYS I WILL NEVER FORGET OR FORGIVE YOU FOR PUTTING ME HERE, YOU JUST DONT' WANT ME ANYMORE. With her attitude and her combative outbursts, I could not live with her. I can deal with her knees and her arms sore, I clean her house, clean her, clean her clothes, clean her dog, take her food for everyday, fix the dinner of the days I am up there but she is an hour away from me. Right now I have her dog and got her cleaned up, to the vet, groomed, under antibiotics, had all her carpets cleaned, took all the pillows, afghans, bedspread, coats, clothes, blankets to my house to clean and return. Her house is CLEAN now. she also had her cataract done after the hip replacement so now she can see out of both eyes, the other cataract was done last year and this was scheduled before she fell. I've been going up there almost daily an hour away, taking her special treats, I have t do her clothes so I take them back there when clean. the nurses told me to stop coming so much before I get sick. I call and then I get the I won't forget or forgive you. Everyone tries to tell me not to take it to heart but it is so hard not to. It cuts right in. She is the quilt trip queen of all time besides.