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Tuesday, May 16, 2006

Hip Fractures

The earlier posting about falls and hip fractures received a very good response from readers. The most recent communication was a call last night from an overseas reader whose mother (In her late 70’s and suffering Alzheimer’s) had suffered a hip fracture from a fall earlier in the day and was now dosed up on morphine recovering from surgery. He feared that this might be the last straw for her: He wanted to do everything he could to help her recovery.
First of all, it must be emphasised that it is not the fall that kills the frail elderly; it is the complications that follow as sure as night follows day, including infections and blood clots that do the killing. If the elderly person survives the initial injury, they tend not to fully regain their past independence and quality of life due to incomplete recovery, poor mobility and worsening of existing ailments, like heart disease. The need for additional medication can complicate recovery and may further dull senses that are already at low ebb, including balance. Several days of complete bed rest alone can knock the stuffing out of an elderly person – let alone the stress of the initial physical trauma, drugs, surgery, medications and any complications!
So; survival, let alone recovery from a hip fracture is a complex challenge that may be further complicated by conditions like Alzheimer’s. Here is the advice that I have for him to consider over the first few weeks in rough order of priority:
  • Appoint an assertive Guardian Angel to hover over her to ensure that she gets the best care available. In this case, the Angel is you.
  • Reduce the risk of infection. This frail woman is vulnerable to infection because she has a deep wound and her immune system is weak. Anybody with a cold or sniffle should be asked to stay away until fully recovered. Start by washing your own hands and insist that everybody who enters her space does the same before touching her. This should include medical staff (even if they are using disposable gloves) and their equipment (namely, the stethoscope) should be sterilised with alcohol. Research has shown that hospital staff is more diligent with hygiene if a patient’s family ask for such care.
  • Prevent blood clots. Express your concern of this risk to her specialist and ask what measures are in place to reduce the risk. Get a physiotherapist appointed within 24 hours to commence passive and active mobilisations at the earliest possible time. This should be at least twice daily to minimise physical wasting from bed rest and to keep the blood in the limbs flowing. Daily flax seed oil and fish oil with vitamin E help keep blood thinned; but talk to her specialist about this first, because any prescription anti-clotting medicines may need to be modified in dose.
  • Make sure that she has a proper treatment plan. Every hospitalised patient should have a detailed written treatment plan that shows how all the various resources and services are brought together in a coordinated way to smoothly progress her recovery and bring about her eventual discharge. If there is not one, then ask why. As the treatment plan is updated, planning should commence early to include her post-discharge care.
  • Get her onto a Super Smoothie within 2-3 days. The Smoothie should include whey protein and anti-oxidant packed red berries. This should be given twice or more times a day and can be regarded as being her primary nutrition source. Make it up at home and bring it in a thermos and get her to consume it while it is fresh (You can drink any that is left over).
  • Include a multivitamin (Nutra-Life Women’s Multi in this case) that contains Vitamin D. (Give 2-4 per day during this period of stress). If necessary, pulverise and add to the Smoothie. If a raw egg is added to the Smoothie (recommended), then administer B Vitamins an hour or so either side because raw egg protein inhibits some of the B uptake.
  • Give a joint and cartilage repair formulation as a refreshing drink (Nutra-Life Joint and Cartilage Repair is best because it contains creatine that assists restoring muscle strength and energy levels as well. Although designed for joint repair, these also assist bone healing. Add to a Red Seal effervescent drink and you are covering most bases as well as getting fluids into her.
  • Give 1-2 grams per day of additional Calcium to assist bone healing and to reduce further bone loss during bed rest. Again, the tablet can be pulverised and added to the Smoothie. Nutra-Life Phyto Calcium or Calcium Complete will do the job.
  • Prepare the home. Ask that an Occupational Therapist be appointed to her case early and arrange for a visit to your home. Plan in advance for caring for her at home. Some modifications may have to be made to the home to improve access and extra help may be required with tasks like bathing. Some financial assistance may be available from agencies like ACC for these modifications and ongoing assistance.
  • Look after yourself. In rehabilitation, it is the caregiver who is usually the most neglected person: alcoholism, depression, social isolation, financial hardship and sheer physical and emotional exhaustion are common. Talk to the hospital and social services support services about what can be done to assist you during this period of stress and over the long term. Ask for help and do so often.
Note: All of the nutritional products that are recommended in this article are available from and can be delivered just about anywhere on the planet.

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