A startling 1 in 5 people over 65 who undergo hip fracture surgery will die within a year according to the Centers for Disease Control. Certainly, a fractured hip doesn’t kill outright – rather it’s the slow healing time that makes a person susceptible to other problems which cause death. We can trace the reason for death back to one thing: immobility. There are steps though that you can take to ensure the best outcome for your loved one.
Humans are not meant to be immobile for any prolonged period of time. When we are the following changes may occur:
- Skin breakdown
- Muscle atrophy
Let’s review the significance of each of the above problems.
1. The Hows and Whys of Skin Breakdown
Prolonged immobility leads to pressure ulcers. Indeed, very little pressure is needed before the blood supply to the area is compromised and tissue damage occurs. We measure pressure in millimeters of mercury (mm Hg) – the same measurement we use in blood pressure.
The pressure required for tissue damage to start is minimal (greater than 35 mm Hg for those who have blood pressure cuffs and want to try this out). This pressure decreases the blood supply to the tissue which then becomes starved for oxygen. The cell hemorrhages and then dies.
In order to know what 35 mm Hg pressure actually feels like, think of the pressure exerted on your arm when you have your blood pressure taken. Now 35 mm Hg is not the kind of pressure you feel when the cuff is fully inflated but rather the pressure that you feel when the cuff is just beginning to inflate after several pumps.
If you can’t remember what that feels like, that’s the point – it’s so minimal. So the next time you’re laying on the floor consider this: the pressure between your hip and a hard resting surface can exceed 300 mm Hg.
Post-operative patients have very limited mobility because of the effects of anesthesia, pain and weakness so they are not able to shift their weight around – things that we all do unconsciously thousands of time a day. That’s why frequent position changes, heel protectors, and skin hydration are all crucial during this period.
When we are laid up in bed for several days, we don’t fully inflate our lungs nor are we able to easily cough and move secretions around. The tiny air sacs that are at the end of our bronchial tubes collapse when they are not properly inflated with air, a condition called “atelectasis”. After several days, bacteria can then build up and lead to pneumonia.
That’s why patients are encouraged to cough and deep breath after surgery especially because normal moving about is severely restricted. An incentive spriometer, a cylindrical device with a tube attached that the patient sucks on, is an inexpensive tool that encourages deep breathing and complete aeration of the lungs.
3. Muscle Atrophy
The process of healing after hip surgery is a long one involving physical therapy and a willingness on the individual to do the exercises. But the weeks of limited mobility lead to muscle atrophy, causing individuals to tire more quickly which then leads to greater limitations.
The hard work of physical therapy can not be underestimated even though the gains may seem so minimal at first. The goal during this initial post-op phase is to maintain muscle tone and strength in the face of limited activity. That’s why it is also important to make sure that pain medication is given before each session in order to maximize results.
Hip surgery is hard at any age but much more difficult on the elderly whose ability to bounce back quickly is diminished by a slower healing time. This combiined with the following, contribute to depression:
- Loss of independence
- Fear of being placed in a nursing home
- Fear of further falls
- Discouragement because of the slow progress
In many cases, depression is accompanied by loss of appetite and poor sleep, both key components in insuring successful healing. The use of anti-depressants and nutritional supplements can help.
Because anti-depressants may take a while before their benefits are felt, be especially alert for the first signs of depression so that medication therapy can be intiated promptly. Be sure to seek out the help of the facility’s social work and pastoral care staff.
Individuals do heal from hip surgery and return to independent living but it requires interventions and cooperation from mutiple disciplines:
- physical/occupational therapy
- social work
- dietary and finally,
- patients and families.
Focusing on these aspects of care will help maximize healing.