My mom (91) fell and broke her pelvis. She is now refusing PT. Any advice?

My 77yo mother broke her pelvis in two places and after being in the rehab a few days, she started refusing as well. She was also diagnosed with early stage Alzheimer's disease. While in rehab, she was cooperative and then she wasn't. I was told that she can't be left alone at home and will need a nursing home soon. She also has Parkinson's and rheumatoid arthritis. She broke three ribs before the broken pelvis. I was was feeling burned out and her hospitalization gave me the break I needed. I think the refusing therapy of any kind shows that they are just tired of the exercising. I explained to my mom that she should try to stick to her OT if she doesn't want PT. Then gradually reintroduce PT. When possible, I would ask what exercises are being done and try to have her do them with me. Explaining once they make up their minds can be aggravating.

I had a broken pelvis and I totally understand that she would rather be dead. The pain is unimaginable and this was after having two children with no pain relief or local anesthetic and had vaginal tearing. That was a walk in the park compared to the pelvic fracture. AND I was told by both my physical therapist friend and the orthopedist to not try to start physical therapy until after the healing had occurred. Yes, for her at this point being moved in any way will cause extreme pain. The best thing for you all is to find out the best way to help her through the pain - using a gait belt to help move her, find a comfortable position in bed, find a comfortable chair (high, cushioned but firm and flat, straight back) use a walker and i used a sturdy office chair to be rolled from one place to another in the house. She will scream at the change in position but you just need to power through and then when she's settled in the new position the pain will subside. With dementia she may never recover but at this point trying to make her "move" is cruel and pointless. Please consult with the doctors and therapists about the need for physical therapy at this point and work on just convincing her to move from bed to toilet to chair and she will need significant help with all of this.

sbartku: Deepest condolences on the loss of your father. Unfortunately your mother does not possess the capacity for physical therapy as someone with a broken bran due to dementia cannot accomplish it.

SB, I am wondering how your Mom is doing. Any better? And is she getting adequate pain relief?

Ultimately, she needs to 'go along' with her own personal / health care, even if she has dementia. Otherwise, it is using force - physical force - for someone's 'good' (and I believe that is illegal (with the exception of if she is hitting someone, then restraints could be used; she is not allowed to physically abuse anyone, or perhaps herself - although check the legal perimeters with the appropriate Association / medical association - of what is allowed) --- this has to do with a patient's rights.

I'd understand mild stage to mean that she is frightened, confused, depressed, responding to medication(s), frustrated, in pain ... and possibly having thoughts of 'you are out to get me.' She will resist as she believes she is protecting herself. And, she may be 'fed up' and just giving up.

The best, if not the only way, to support her well-being is to learn how to communicate with her - and then she has the final word:

1. Talk calmly to her (in an even quiet tone - no screaming).
2. Smile while making eye contact.
3. Reflect what she says back to her (let her know you are listening to her).
4. Provide gentle touch if it is well received (neck massage, shoulder massage, touch her hair while looking into her eyes).
5. She wants to FEEL cared for and she will 'get' these kind loving gestures.
- As you build up trust through these communication ways, she may start to let PT to happen ... although so much also depends on how the PT works with her. That person needs to take their time with her as you will / do. And, realistically, their time is limited. Do all you can to 'prepare' you mom for PT. Do the above (massage, focused attention, and let her know the PT is coming in xxx 1/2 hour so she will know. If she is able to understand, tell her: "xxx, the PT is coming over and it is entirely up to you if you want to work with her / him." Giving her the power to make these choices, even though she already has this power, may help her feel more in control of her life and the decisions she makes = she will feel better and possibly not be 'so' resistant.

Still. Nothing may work to meet this (PT) objective.

One of the hardest realizations to learn is that we / loved ones / family / paid caregiver / manager (me) / medical professionals want to do and try to do, we can only 'do' some much and then we need to let go, accept a person where they are and go from there.

Frustration, overwhelm, depression, dealing with loss of independence, and change, physical PAI, support systems and prior/lifelong patterns of behavior all affect how a person will decide to move in their life - then there is the addition of dementia (which changes / colors everything else.

The best you might be able to do is accept where she is and what she wants, understanding and empathizing with her discomfort and pain.

It is important to remember that it is the brain that is changing. The person cannot make logical / healthy life decisions as they once could/did.

When she says no, try to give her a gentle massage to relax her. That might be all you can do in the moment - and she will appreciate the care and comfort it brings.

Gena / Touch Matters

Been there. My wife broke her hip 2 years ago. She refused the rehab. She has slowly declined over the last 2 years. She is Bed bound now and wears a diaper. She is now getting contracture in her legs. I am trying to force therapy on her but she plays the game she is not feeling well.
as with most things in life you can not force someone to do something they do not want to do.

I suppose you could have her checked by the doctor to make sure her pain is not a reflection of something wrong after the surgery. She may have been re-injured and no one‘s fessing up.

otherwise just keep loving and encouraging her through the protests. And listen to her. She may need a time to vent her grief still. Find an old friend of hers to call her or visit her. Help her reconnect. God bless you

My mom broke her pelvic in her 90’s not much they can do for that, except let it heal. It us painful but PT does help. Percocet goid be making her loopy. It did me when I had foot surgery. I felt fully drunk. Never took the second dose. Just dealt with the pain.

If she continues to refuse PT, she may be discharged from Rehab sooner than if she were participating and showing improvement. If she is in pain and is immobile, she probably does want to "lie there and die.". She may regain some perspective and optimism over time. She may not.

Where will she go if she is bedbound? SNF? Or are you planning to bring her to your house (EEEKKK!!!)?

I don't see AL as being appropriate anymore, do you?

If she doesnt want therapy that is her choice & her life. Be with her & support her she will come around when ready...remind her how much you love her.

Ask her Dr as we are not doctors.

Is Hospice possible ? I would ask for a hospice evaluation and see if she qualifies… had my MIL in the ER and the care representative said she wouldn’t qualify. A couple days later, The memory care called a hospice for an evaluation, yes she did qualify.

with hospice comes the added care. A wheelchair , hospital bed , hoyer lift, care supplies. RN weekly who will manage meds with physician. CNA twice a week

hospice doesn’t mean imminently dying. She would be reevaluated periodically. I read here where their loved one was on hospice for long periods of time…

Pain of #pelvis + very advanced age can = becoming bed-bound.

Bed-bound + reduced mobility to turn can = pressure sores.

Get all the right OT equipment;
to aid standing, transfering, comfortable chair for sitting, pressure cushion & air mattress to reduce risk of pressure injuries ✔️

Regular visits & encouragement from PT ✔️

Begin the process of adjusting expectations as time goes on.

Acepting the new normal.

(((Hugs)))

In a different set of circumstances my dad was in a cycle of hospitalizations for CHF, often followed by rehab for weakness in walking, and back to a new, albeit lower baseline. We kept encouraging him to “try harder” in rehab and with home PT. What took us so long to grasp was that he simply had no no “try” left in him. Yes, some of it was depression as he’d experienced so many losses of people and abilities, but much more of it was being so very tired of the illness and hardships life had become. He chose to leave the final rehab place and come home on hospice. He died less 2 months later, with much sadness for us but with complete contentment for him. Sometimes life here just gets too hard, that’s what I learned. Not sure this is what’s happening with your mother, but something to consider. I wish you both peace

Thanks everyone for your ideas and concern. She is on something for sleep/depression - trazodone- that she takes at night. That may need to be reevaluated. I will have to ask about the fentanyl patch too.

You may need to speak to her physician about a change in pain medication. She may be experiencing nausea, lightheadedness, dizziness; these are some side effects of Percocet. Constipation is also something that is caused by pain medication so it is a good idea to monitor her bowel movements. The lightheadedness and dizziness usually occur with movement such as turning from side to side or standing. She may need pain medication that is longer acting such as Fentanyl patch. Pain medication that is administered as needed(PRN) is usually not as effective in controlling pain in elderly persons. She may also be experiencing some grief due to the loss of her husband. Since she now requires more assistance and care than when she was in assisted living you may need to be thinking about SNF placement.

It’s a very sad situation.

I’ve visited my LOs in rehab, and in one there was a very fine doctor who was head of the place. I learned how forceful he could be in advising patients in similar circumstances as your mom. He raised his voice and told them in no uncertain terms where they’d end up if they didn’t follow the program. He made it sound like a circle of hell. It was his way of motivating, giving them a last chance to respond to treatment.

I don’t think it ever worked because those patients disappeared to long-term nursing across the street.

Sometimes all you can do is give up. Your mom will do what she wants to do, and maybe she knows best. Keeping her alive to experience full-blown dementia may not be such a great idea. I’m very sorry you’re going through this.

Alva is correct ,
Pelvic fractures are very painful . People with them tend to not want to move.
Effective pain management , with pain med on board an hour before therapy starts or a Fentanyl patch may help .

However , Depending on how advanced the dementia is she may not be able to do PT successfully .

Like Alva said she may not move ( walk ) , again . Unfortunately this does happen with the elderly with dementia. I’ve seen it with hip and femur fractures as well .

My mother was fully mobile - an avid walker - when she was hospitalized. In fact she kept trying to escape. Illness, not injury. A few weeks in she got angry and refused to ever move again. Wouldn’t even feed herself or roll over. (lots of tests) Raged at the PTs. Did stage a few escape attempts when nobody was looking. She was late mid-stage at the time.

While it is likely that your mother has untreated pain or a fear of any movement as her mind may tell her she’s falling, I am sharing my story because my mother suddenly stopped moving, without any injury. Incredibly frustrating - her own worst enemy. And that was one year ago.

Did they look beyond the pelvis for spinal or any other fractures?

I would discuss with her doctor. She is getting quite a powerful pain medication, yet it seems not to be working for her. I can assure you that any break in the pelvis is notoriously painful, no matter even passive PT exercises (done with the therapist moving the limbs gently.

Just occasionally an injury with this level of acute pain can spell the beginning of the end. There may be medications that can be added that will boost the pain medication itself, and she may need more pain meds for a while, perhaps even a fentanyl patch.

Discuss with MD. This is a case of doing the best you can and hoping that the immobility doesn't create further, and worse problems, because it may. I am truly so sorry. Think of it as an injury in which the tiniest movement of any part of your body results in acute pain in the core. I wish you the best, but I think she needs better pain management.

PT and OT in rehab with a dementia patient is an exercise in futility, as are pep talks for someone with a brain disease . They have neither the ability or the desire to exercise, nor should they be forced into it ( especially with pain being a factor) or convinced to comprehend something they simply cannot.

Hospice is also a good idea if there is no chance of improving. And with just dementia at play, there is no chance for improvement, unfortunately. Also, if there are drugs to "slow the progression" of Alzheimer's, I'm unaware of them. Besides, why would anyone want to prolong an elders battle with such a dreadful disease?

Anti depression meds may help, but mom may be approaching the end of her life now which hospice can assist with. After a certain point, it's impossible for an elder to recover from so many health blows, and so begins the final leg of their earthly journey. Once my father gave up, he passed away 19 days later from an inoperable brain tumor. Hospice kept him comfy in his AL apartment who agreed to keep him until death. Dad made no progress either in rehab, so he was released in pretty short order.

My condolences on the loss of your dad, and watching the wretched progression of AD which I went thru w my own mother.

Do they schedule the pain killers so that they kick in before they start rolling her?

Have you consulted with the surgeon about aggressive PT should be?

I would consider that hospice might be one of the things you consider.

Also, an evaluation for depression.