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  #1  
Old 07-20-2012, 09:44 AM
AndyLee AndyLee is offline
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Do Old People Really Fall, Break A Hip, Then Go Downhill

I work part time in a fancy club.

There is one member there that is 86 years old. He is really active and tells me he's never been sick a day in all his life. He used to smoke but hasn't since he was 40.

But often he seems to really charge down stairs or move way too quick for my liking.

You know how you always here, "He was fine, till one day he fell, broke his hip and that was that." Then they die.

Does this really happen? I know you can't be exact but if it is common, why do people who are pretty healthy go downhill so quickly once they break a hip?

This person has a lot of money so would be able to get the finest health care anywhere in world actually, if that would mean anything
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  #2  
Old 07-20-2012, 09:49 AM
SanVito SanVito is offline
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It's a very serious injury that renders the victim bedridden for a long time and takes many months of physiotherapy and often further operations before they recover. Even then, a full recovery is not guaranteed.

Combine this with old age and you can see how recovery is considerably harder than for a younger person. Some people just never fully recover full mobility.

My mother broke her hip when she was 60. Thankfully she was still young and fit enough to cope with the recovery, but it still took months.
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  #3  
Old 07-20-2012, 09:51 AM
kenobi 65 kenobi 65 is offline
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From the Centers for Disease Control:

- One out of five hip fracture patients dies within a year of their injury.

- Treatment typically includes surgery and hospitalization, usually for about one week, and is frequently followed by admission to a nursing home and extensive rehabilitation.

- Up to one in four adults who lived independently before their hip fracture remains in a nursing home for at least a year after their injury.

Now, the first point may be correlation rather than causation (a lot of hip fracture patients are elderly, and may have died within a year regardless of the injury).

However, the second and third points suggest that it's a difficult injury to rehabilitate, and the rehab time may be very lengthy. As we get older, our bodies tend to heal more slowly, and I imagine that a hip fracture leads to very limited movement until it heals.
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Old 07-20-2012, 09:53 AM
D18 D18 is offline
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According to this study after surgery for a hip-fracture, 27.3% were dead within a year and 79.0% were dead within the follow-up period (up to 9 years). The authors estimated that the mortality was 3 times that of the general population of age- and sex-matched people.
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  #5  
Old 07-20-2012, 09:54 AM
Nawth Chucka Nawth Chucka is offline
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Right after her nephew and his family left Thanksgiving evening 1987 my great-grandma fell and broke her hip. She lay on the floor till Saturday when he got worried enough at her unanswered phone to come back over. They put her on painkillers for the surgery and no one ever heard from the woman we all knew again. She healed well physically but her mind was gone and she spent another 6 years in a nursing home stealing from other rooms and being very confused before pneumonia got her.
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  #6  
Old 07-20-2012, 09:57 AM
mozchron mozchron is offline
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That's how my grandmother eventually went. She fell several times, broke both hips (one of them twice), ended up in a wheelchair, then in a (very nice) nursing home. Fell again trying to get out of bed (grandma HATED asking for help), broke her hip AGAIN, couldn't use the chair anymore and was bedridden, got pneumonia and died.

Took about 5 years. She was 93 when she passed.

The first hip broke when she fell off a step-stool to get something off the top of the fridge. Waited on the floor for 9 hours until me and my brother found her after school. That healed and she used a walker afterward.

The other 2 falls were the bitch. Turns out they were caused by the medication her idiot Dr. had her on - dropped her blood pressure until she passed out. The one that put her in the chair and nursing home happened in the hospital.

Final one that killed her was grandma's own fault. She wanted to get out of bed and into her chair, and didn't want to "bother" the nurse.
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  #7  
Old 07-20-2012, 10:03 AM
AndyLee AndyLee is offline
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Interesting, I just like this old guy but try to tell some 86 year old what to do and see where you get. Try to tell an 86 year old with 50 million in the bank and see how that goes LOL
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  #8  
Old 07-20-2012, 10:06 AM
pravnik pravnik is offline
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In an older person, major surgery can put them at a risk of postoperative cognitive dysfunction, especially if they were anesthetized for a long time. If they have dementia as well it can really exacerbate it, and it can be really difficult to rehab a hip injury when somebody's cognitive functioning is heavily impaired. My mom has some mild dementia and fell and broke a hip late last year (and then broke the other socket a month or two later), and was really out of it for quite a while, especially immediately after the surgery. She's only just now getting back to where she was mentally, much to our relief.
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  #9  
Old 07-20-2012, 10:28 AM
TriPolar TriPolar is offline
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Happened to someone around here less than a year ago. Not even a broken hip, just broken ribs. Gone in two weeks.
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  #10  
Old 07-20-2012, 10:33 AM
Procrustus Procrustus is offline
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Some of this might be correlation without causation. When you're old and brittle enough to fall and break a hip, you might be old and brittle enough to be near death. In other words, they may be been dead within a year without the fall and the break.

However, as others have pointed out, once you have a major medical problem and you're old, things can go down hill quickly.
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  #11  
Old 07-20-2012, 10:33 AM
Nawth Chucka Nawth Chucka is offline
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Originally Posted by pravnik View Post
In an older person, major surgery can put them at a risk of postoperative cognitive dysfunction, especially if they were anesthetized for a long time. If they have dementia as well it can really exacerbate it, and it can be really difficult to rehab a hip injury when somebody's cognitive functioning is heavily impaired. My mom has some mild dementia and fell and broke a hip late last year (and then broke the other socket a month or two later), and was really out of it for quite a while, especially immediately after the surgery. She's only just now getting back to where she was mentally, much to our relief.
Thank you for that link, pravnik, it explains a lot. Grandma certainly had already lost some cognitive function in the 3-4 years before her fall; we'd find rotted food or no food in her kitchen and after she was taken to the hospital it was found she had simply been tossing her bagged trash down the basement stairs. She'd also continued to pay the car insurance for grandpa's car which was sold when he passed in 1976.
Peace and continued healing to your mom.

Last edited by Nawth Chucka; 07-20-2012 at 10:33 AM..
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  #12  
Old 07-20-2012, 10:48 AM
Dano83860 Dano83860 is offline
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Small hijack.

Interestingly enough it is not unusual for the break to happen first causing the person to fall. My mothers doctor said that this happens in about a quarter of the cases.
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  #13  
Old 07-20-2012, 12:43 PM
mo50 mo50 is offline
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My limited understanding is that infection after surgery can also apparently be a factor. My MIL just passed after a fall that resulted in a broken hip. She had surgery, went into a nursing /rehab facility, got a staph infection, and that seems to be what finally got her.
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  #14  
Old 07-20-2012, 01:11 PM
control-z control-z is online now
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Originally Posted by Dano83860 View Post
Small hijack.

Interestingly enough it is not unusual for the break to happen first causing the person to fall. My mothers doctor said that this happens in about a quarter of the cases.
Right, I came here to post that. Sometimes the hip breaks first, then the fall. Get plenty of calcium boys and girls.
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  #15  
Old 07-20-2012, 01:14 PM
needscoffee needscoffee is offline
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You lose 10% of your muscle mass with each week you are immobilized in bed. Elderly people have very little muscle mass to begin with, so being laid up for several weeks with a broken hip means they're then too weak to build back up the muscle strength needed for rehabilitative recovery. Additionally, being immobilized horizontally in bed leads to pneumonia and other lung issues, decreased heart pumping effectiveness,

Here is a description of some of the physical changes resulting from immobilization: http://www.ncbi.nlm.nih.gov/books/NBK27213/
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  #16  
Old 07-20-2012, 01:40 PM
ethelbert ethelbert is offline
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I don't think young healthy people appreciate how debilitating being bedridden can be (for anyone, but obviously the elderly have fewer resources to call on to help them bounce back). Every time my mom (early 90's) went to the hospital (stays of only a few days) she came back visibly diminished, both physically and mentally, even after two weeks of PT and OT.
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  #17  
Old 07-20-2012, 03:35 PM
barbitu8 barbitu8 is offline
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Originally Posted by needscoffee View Post
You lose 10% of your muscle mass with each week you are immobilized in bed. Elderly people have very little muscle mass to begin with, so being laid up for several weeks with a broken hip means they're then too weak to build back up the muscle strength needed for rehabilitative recovery. Additionally, being immobilized horizontally in bed leads to pneumonia and other lung issues, decreased heart pumping effectiveness,

Here is a description of some of the physical changes resulting from immobilization: http://www.ncbi.nlm.nih.gov/books/NBK27213/
Generally speaking, you do lose some muscle as you age, but if the person works out, does weight lifting 3 times a week, that person will not lose muscle mass, and can still gain more strength. So even an "elderly" person will still be in good shape after several weeks, if that person was in good shape before the injury.
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  #18  
Old 07-20-2012, 03:38 PM
kenobi 65 kenobi 65 is offline
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Originally Posted by barbitu8 View Post
Generally speaking, you do lose some muscle as you age, but if the person works out, does weight lifting 3 times a week, that person will not lose muscle mass, and can still gain more strength. So even an "elderly" person will still be in good shape after several weeks, if that person was in good shape before the injury.
But, in all honesty, how many elderly people would fall into that category?
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  #19  
Old 07-20-2012, 03:40 PM
Skald the Rhymer Skald the Rhymer is offline
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Yes. My favorite college professor died that way.
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  #20  
Old 07-20-2012, 04:27 PM
needscoffee needscoffee is offline
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Originally Posted by barbitu8 View Post
Generally speaking, you do lose some muscle as you age, but if the person works out, does weight lifting 3 times a week, that person will not lose muscle mass, and can still gain more strength. So even an "elderly" person will still be in good shape after several weeks, if that person was in good shape before the injury.
You lose 10% of your muscle mass per week when you are immobilized in bed, whether or not you were in good shape before the broken hip.

After age 40, we lose 8 percent or more of muscle mass each decade, and more after age 70, unless we are actively working out. The question was "why do people who are pretty healthy go downhill so quickly once they break a hip?", not "how can we prevent it."
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  #21  
Old 07-20-2012, 04:50 PM
VOW VOW is offline
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The treatment of broken hips has improved greatly in the past 100 years. By putting a pin in the break and immobilizing the fracture site, patients can become mobile much earlier. This reduces the chances of blood clots leading to strokes and heart attacks, and promotes deep breathing.

Before the surgery became commonplace, the ONLY solution was complete bedrest, and any movement which caused the broken bone to shift (such as turning for a bedpan, or sheet changing) and resulted in horrific pain. The person would conclude that moving as little as possible for ANY reason was the best way to go.

As a result, blood clots would develop in the legs and break off to travel to the heart or brain, or the inability to breathe deeply would encourage pneumonia. Pre-antibiotic days meant pneumonia would cause a rising fever and death would soon follow.

The old family doctors often called pneumonia "the old peoples' friend."

Recovery these days depends a LOT on the attitude of the person with the busted hip. Active participation in physical therapy and a DESIRE to return to "normal life" will promote a faster recovery than someone who just wants to sit back. Physical therapy HURTS, and many simply do not want to work past the pain.


~VOW
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  #22  
Old 07-20-2012, 05:13 PM
crowmanyclouds crowmanyclouds is offline
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Originally Posted by needscoffee View Post
... being immobilized horizontally in bed leads to pneumonia and other lung issues, decreased heart pumping effectiveness, ...
and pressure ulcers, AKA bed sores,
Quote:
... Although often prevented and treatable if found early, they can be very difficult to prevent in frail elderly patients, wheelchair users (especially where spinal injury is involved) and terminally ill patients. Bedsores are often fatal—even under the auspices of medical care—and are one of the leading iatrogenic causes of death reported in developed countries, second only to adverse drug reactions. ...
CMC fnord!
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  #23  
Old 07-21-2012, 12:55 AM
Beth72 Beth72 is offline
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My grandmother died 3 weeks ago. Saturday afternoon she broke her pelvis and she passed away Monday morning right when they were wheeling in the machines that go bing
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  #24  
Old 07-21-2012, 06:02 AM
Crafter_Man Crafter_Man is offline
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Originally Posted by barbitu8 View Post
Generally speaking, you do lose some muscle as you age, but if the person works out, does weight lifting 3 times a week, that person will not lose muscle mass, and can still gain more strength.
Clarence Bass is proof this. Look at his pic when he was 70 years old.
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  #25  
Old 07-21-2012, 06:31 AM
barbitu8 barbitu8 is offline
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Originally Posted by kenobi 65 View Post
But, in all honesty, how many elderly people would fall into that category?
First, you have to define "elderly." I'm 74. I have a few friends older than I who run and work out. One person I know is 83 and does triathlons. If you define "elderly" as over 60, my list of people who I know who do even more than I is endless: marathons, triathlons, ultra-marathons, etc.

So, I don't believe people who are "pretty healthy go downhill so quickly once they break a hip."
I ripped my calcaneous tendon (Achilles tendon) from the bone a few years ago. I was on crutches for some time and then on a walking boot. I lost a total of four months, and resumed just about where I left off. (I was able to swim with the boot.) After testing the strength of my calf muscles 4 months postop, the orthopedist was amazed how much strength I still had in those muscles. Reluctantly, he released me with no restrictions, including playing tennis, but not to play tennis games for a while. (I did actually start playing tennis games after one or two days of just hitting.)
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  #26  
Old 07-21-2012, 06:51 AM
Antigen Antigen is offline
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Originally Posted by needscoffee View Post
You lose 10% of your muscle mass with each week you are immobilized in bed. Elderly people have very little muscle mass to begin with, so being laid up for several weeks with a broken hip means they're then too weak to build back up the muscle strength needed for rehabilitative recovery. Additionally, being immobilized horizontally in bed leads to pneumonia and other lung issues, decreased heart pumping effectiveness,

Here is a description of some of the physical changes resulting from immobilization: http://www.ncbi.nlm.nih.gov/books/NBK27213/
Not to mention the fact that a lot of this recovery time is taking place at a hospital or long-term care facility of some sort, both of which are great places for the spreading of infections among patients. Bugs like influenza, pneumonia, Staph, and C. diff., many of which carry antibiotic resistance already and are pretty dangerous to folks whose defences are impaired.
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Old 07-21-2012, 08:31 AM
needscoffee needscoffee is offline
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Originally Posted by barbitu8 View Post
First, you have to define "elderly." I'm 74. I have a few friends older than I who run and work out. One person I know is 83 and does triathlons. If you define "elderly" as over 60, my list of people who I know who do even more than I is endless: marathons, triathlons, ultra-marathons, etc.

So, I don't believe people who are "pretty healthy go downhill so quickly once they break a hip."
I ripped my calcaneous tendon (Achilles tendon) from the bone a few years ago. I was on crutches for some time and then on a walking boot. I lost a total of four months, and resumed just about where I left off. (I was able to swim with the boot.) After testing the strength of my calf muscles 4 months postop, the orthopedist was amazed how much strength I still had in those muscles. Reluctantly, he released me with no restrictions, including playing tennis, but not to play tennis games for a while. (I did actually start playing tennis games after one or two days of just hitting.)
None of this is comparable to the complete immobility that arises from a broken hip. Crutches and a walking cast means you are walking. And the percentage of elderly people who are athletes, or who even work out heavily, is miniscule. Obviously, the more fit you are, the better able you are to withstand debilitating injury.
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  #28  
Old 07-21-2012, 12:27 PM
Miss Mapp Miss Mapp is offline
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Originally Posted by control-z View Post
Right, I came here to post that. Sometimes the hip breaks first, then the fall. Get plenty of calcium boys and girls.
I've been trying to find a cite for this--I know I just saw it in some patient brochure or Web page about osteoporosis a week or so ago. When the bones begin to become fragile, the part of the femur just below the hip socket is one of the most vulnerable points for breakage.
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  #29  
Old 07-21-2012, 12:28 PM
VOW VOW is offline
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Originally Posted by needscoffee View Post
None of this is comparable to the complete immobility that arises from a broken hip.
Rare to have COMPLETE immobility, with today's orthopedic surgical techniques with pins and plates and even complete hop replacement The object is to get the patient up and moving almost immediately. Restricted movement, yes, but there is physical and respiratory therapy as part of the surgical recovery.


~VOW
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  #30  
Old 07-21-2012, 01:05 PM
jtgain jtgain is offline
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I don't understand why this is such a mystery. The body has a limited life span. Elderly people are on the downward slope of this span. Anything, let alone something as drastic as a hip fracture, would accelerate this decline. An older body doesn't have the regenerative powers of that of a 19 year old.
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  #31  
Old 07-21-2012, 04:01 PM
barbitu8 barbitu8 is offline
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Originally Posted by jtgain View Post
I don't understand why this is such a mystery. The body has a limited life span. Elderly people are on the downward slope of this span. Anything, let alone something as drastic as a hip fracture, would accelerate this decline. An older body doesn't have the regenerative powers of that of a 19 year old.
Your last sentence, although true, is a non sequitor.
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