Should an elderly person with severe malnutrition anemia get physical therapy for reconditioning his new hip without addressing the anemia?

No, this does not sound right.

Superhawk, thanks for sharing this information. It helps in understanding your thread on the development and treatment of pressure ulcers. For others, this related thread is:

https://www.agingcare.com/questions/any-practical-advice-for-a-total-novice-on-wound-care-for-unstageable-pressure-sore-management-458954.htm

I don't understand though how he could have been deprived of food and water for "days", while waiting for surgery. Was he given any kind of infusion sustenance?

Anemia doesn't creep up; it has a cause, and the issue of hemoglobin needs to be addressed. He can get an iron shot (which a doctor suggested when I was anemic), or he can take iron pills - dependent on what a doctor evaluates.

Shane can offer better insights on this, but I would think that addressing anemia will help him become stronger and more able to heal, all over.

And there are gentle exercises that can be done while laying in bed, very controlled ones that don't exhaust him. But he needs nutrition to support his recovery. And he needs and is entitled to a coordinated approach to recovery.

It seems to me that the course of treatment is somewhat disjointed; he needs to become stronger to heal from the surgery as well as the pressure sores.

Have you been to this hospital before?

What type of anemia does your Dad have? Pernicious anemia is caused by a lack of B12 and is not linked to iron intake.

Where was Dad prior to surgery that he was not given any nutrients?

Who has diagnosed the anemia?

Yes. I don't understand why no food or water at all. This could have caused so many problems. Even being too weak for an operation.

Talk to his doctor, talk to his nurses; this is wrong. Going days without food or water sounds like a medical screwup, but not not enough to cause anemia. And his anemia and nutrition do need to be addressed. Maybe you should change doctors and PTs.

If he was in pain, he may have refused food. If he was in hospital, he may have had IV fluid. But it does not have nutrients. There is more to this story that the medical staff withholding food. Elderly people often have failure to thrive. Even when they eat, they don’t absorb food properly. My FIL had anemia for years. He rarely ate red meat. He took iron which did not really help. He had chronic low grade kidney failure which also contributed to anemia
2 weeks ago, my FIL was found to have extremely low hemoglobin which did not improve much after 2 units of blood were given. He likely had some condition that was causing bleeding somewhere but at 95, with dementia, we elected not to put him thru any investigation of the source.
There are hazards to bed rest. PT is ordered to try to mobilize patient. It was ordered by the doctor. OP needs to have this discussion with his doctor. We don’t have enough information to provide advice.

It depends on how anemic he is.

My question was why his anemia wasn’t found before he had surgery. Everyone has pre-op labs done. He may have lost some blood during the surgery to have caused the anemia, or not. Why wasn’t this found before?

A lot of variables here. We have an emaciated patient with a reddened area on his sacrum from your last post who appeared to have been on bed rest for months prior to surgery. Am I correct?

Where was he before all this happened? People don’t get malnutrition or anemia overnight. Malnutrition is a contributing factor to developing pressure ulcers.

Re his anemia. Often physicians don’t transfuse red blood cells unless the HGB is less than 7-8. Without knowing his numbers it’s hard to tell. Anemia can be caused by many things most common is low iron. Some people are prescribed B12 injections or take it by mouth for pernicious anemia. And of course bone cancer can cause anemia because red blood cells are made in the large bone marrow- femur and iliacs.

For bones to strengthen to produce red blood cells (all blood cells I should say) the bones need to be used and exercised. So your father has to get up and move. His inactivity most likely led to his reddened sacral area.

PT’s don’t order transfusions. The PT person could have just said this in passing without knowing his history. Some patients get CHF when transfused so they have to balance many factors. But if his HGB is not too low he won’t get transfused.

If you don’t like how he is being managed get him another doctor.

He needs to get moving, anemia or not. I suspect a lot of this is dad being tired is not only due to anemia but also because the man hasn’t had any physical activity in a long time. The longer he stays in bed the longer it will take to recover.

Push him to get up and do PT. Standing builds up the bone. Anemia or not, post op hip replacements need to exercise. His doctors can work to fix the anemia but right now dad needs to put some effort into therapy. Make sure they pre-Medicate him 1 hour before PT. I had a hip replacement @ 60 y/o- the pain he is having is post-op pain from the incision because the hip pain should be gone. I had surgery at 7:30am and they made me get up and walk at 6pm- around the nurses’ station! No more hip pain for me.

There’s not really enough info here to give much help. First is what kind of anemia are we talking? Dies he need iron, or is it the kind that is the result of kidney damage? The kidneys make a hormone that they release to signal the bone marrow to make red blood cells. If there is kidney disease they can’t function correctly and do the person has a low RBC count. Treatment is not the same. Neither is the result of a few days without nourishment how old is your dad? Dies he have Dementia? Was he in the hospital a few days with a broken hip before surgery od was it both before and after surgery that he wasn’t eating. Has he been resisting nourishment before the broken hip or did it start with that. If it’s new onset delirium viiid be the cause and that is something that can be alleviated when you figure out what’s causing it and mitigate the need. As we age, however, our nutritional needs change, foods begin to lose their taste and our bodies do not absorb nutrients that we do eat. Protein. Calorie Malnutrition usually develops over a period of time that is much longer than you describe. PT can work with him regardless of treating anemia, but. Think more discussion is needed with the doctors about what is really going on and what can/cannot be done.

Superhawk,

I'm going thru a similar situation with my 90 year old mom who fell and broke her femur last March. She was in the hospital for surgery then acute rehab, then back in the hospital with pneumonia, then back in acute rehab, and finally home May 1st with intensive Home Health Services including therapy. I keep up with all her vitamins and meds. I noticed they put her on an iron supplement at some point, for a new diagnosis of anemia. I believe this was diagnosed in the acute rehab. It's really hard to tell how everything went down because of the coronavirus and not being able to be there at all.

She fell and broke her femur on a Sunday morning and they did not operate until Tuesday afternoon. They did not feed her or give her any liquids prior to surgery, which I know from speaking with the doctors and nurses in the hospital. And they also didn't monitor her fluids in and out after the surgery, which was frustrating because she has CHF also. My mom was borderline anemic , I think, before she fell. They did give her at least one blood transfusion in the hospital after surgery.

Anyhow to answer your question about the physical therapy, my mom is getting Physical Therapy. In our situation and from what I understand from my mom having Home Health Rehab several times for various reasons over the years , is that the therapist cannot prescribe any medication or assess those issues. However, they can notify the care manager in charge of our loved ones care. I don't know if this is your first time dealing with this type of situation. The way that has worked for my mom is there has to be doctor's orders for therapy of any kind whether it's physical, occupational, speech. The Doctor who's writing the orders is supposed to be managing the care. For example my mom currently has Home Health. The company that is managing the Home Health has a PA who comes out and does an assessment and then recommends the therapy. If you're in a facility, there is an attending doctor that does this. You may need to call the attending or the PA yourself. I always make sure I have everyone's phone number and position listed in the planner that I keep for my mom. Do not hesitate to call and request, demand if you have to, any assessments, lab test, treatments , meds, Etc. Also if you're doing home health, there should be a skilled nurse coming out to visit at least once a week; he or she should be able to call and report to care mgr on the spot. Heck, my mom flailed around in her sleep last week and sliced her arm open, and even the home health aide who comes into shower her called the nurse immediately to report the wound. She could not treat the wound as a home health aide, but she could report it. Of course I was there and I treated it but I wanted the nurse to come in and look at it. If you're in a facility then you want to speak to the charge nurse to get in touch with the doctor or the PA and request they call you. There's no reason for your dad to not get treatment during reconditioning. A lot of things pop up and need to be dealt with. But in my experience, the therapist can only alert the medical team of a problem. If they're not doing that, then you'll have to be the one to step in and insist on the better care from the medical team. If your dad is not getting the care he needs and the agency or facility is not responsive to your phone calls, then I would get a different agency or go to a different facility that is more proactive and caring.

My communication regarding my mom is less complicated because I have general power of attorney and durable power of attorney for health care. I wave my papers in everyone's face and when I'm introducing myself I let them know. I have copies ready for distribution and I keep a special copy to make them print their name, facility, date and sign that they received it. When they sign for it, they can see the growing list of receipt signatures , so they know I mean business.

Good good luck in getting your

I was a licensed PT for 40 years and I agree with Shane and dogparkmomma about the need for your dad to get out of bed. Lying in bed does not restore strength. There are several types of anemia and many causes, not all related to nutrition. I'm sure the doctor is aware of his condition.

As an RN, PT does not address this issue. Anemia would generally NOT be a problem associated with a few days of no food. Given his age, it is more likely related to either a long-standing problem of malnutrition or problems with him absorbing B-12, usually called pernicious anemia. The first is addressed with getting him to eat a balanced diet. If he is doing that, then the 2nd issue comes into play - getting B-12 into his body. The most effective form of B-12 to be absorbed is through injections, usually weekly, for the rest of his life.

Since you are concerned about his nutrition, please talk to his doctor. His doctor can have labwork drawn to see if anemia is a problem, to diagnose the type of anemia, and to prescribe treatment.

My dad had physical therapy while anemic, and the PT did help in the short term. He was being treated for the anemia, but it turned out to be incurable MDS, a kind of blood cancer. He was 94 when he died, after being anemic for several years. ( MDS is usually not curable, but I understand it can sometimes be cured in younger people after chemotherapy and bone marrow stem cell replacement. )

As others have pointed out, your father's doctor needs to be treating the anemia, not the PTherapist. PT should begin as soon as prescribed. If you'd dad cannot stand, PT can begin with bed exercises. PT should not wait until anemia is resolved. I Is an important part of rcovery.

Call doctor and ask how the anemia will be treated. Often w/PT, a nurse is also part of the home health care. If nurse not part of it, tell dr to order it. The nurse can help with a variety of things - blood work, checking for bladder infections with urine sampling, perhaps giving the B12 shots if so ordered.

Get a nurse involved in the care.

By all means, treat the anemia. It may be a sign of something else going on that has not yet been diagnosed. My fiance just died two weeks ago, officially from pancreatic cancer but in actuality he starved to death because he couldn't absorb nutrients no matter how much or what he ate. He also suffered from severe anemia (hemoglobin was 8 the last time it was checked by a doctor, despite his taking both iron tabs and Vit. B-12). His weight went from 225 down to below 120 in just over a year. His appetite was good for most of that time.
When he broke his hip last November, it was the final straw. First he didn't like the food in the rehab facility (where they were totally unaware of his anemia until I told them, and insisted upon it being checked again.) Then after coming home to the diet he preferred, he couldn't seem to gain weight ever again. We did the Boosts, the Ensures, his favorite foods, a high-protein high-fat diet, etc. Nothing worked. So was it really the pancreatic cancer? Perhaps. And cancer does dramatically affect blood levels of hemoglobin. But the anemia played a major part in his decline.

Given the number of issues you are having with your dad, I would ask for the Home Care RN to sit with you while you call Dad's doctor together and go over
1. Wound care treatment and plan
2. Anemia/nutrition treatment and plan
3. eligibility for PT
4. eligibility for hospice.

Make yourself a list of all the issues you'd like to get answers to. Are these comments about his being "an old guy" a veiled hint that he needs hospice? If so, they need to speak up and discuss it with you and with your dad, not pussyfoot around.

I don’t think it is your PT that will address this but the primary care doc. Anemia can be serious and will effect healing as well so they will want to take action. My mom needed iron IV

I could be completely wrong but PT people work with the body functioning right, like exercising legs, arms, etc. A primary care physician is the one who is responsible for handling problems with anemia - but they can work together.

Imho, his anemia needs to be addressed in conjunction with the PT.

It is not the physical therapists responsibility to request that the physician address your dad's anemia. I would suggest that you speak with the doctor directly regarding this issue. I also would suggest that you speak with your dad's nurse. The nurses can accept orders from the physician regarding the issue; the P.T cannot. You're correct that the anemia could affect his progression and it should be addressed as there are a variety interventions for it.

Why spent so many days without water or food?? Makes no sense.