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Summary
In this CareLab episode, hosts Brandy Archie and Emilia Bourland are joined by Dr. Brittany Lamb to discuss hip fractures, a common and serious injury among older adults. They cover the physical and psychological challenges faced by patients after a hip fracture and the critical steps in treatment and rehabilitation. The episode emphasizes the importance of mobility, fall prevention, and teamwork in recovery, as well as strategies to prevent falls and complications for better long-term outcomes.
Key Takeaway
- The Serious Impact of Hip Fractures: Up to 40% of hip fracture patients may face mortality within a year due to complications like infections, blood clots, and reduced mobility.
- Importance of Immediate Mobility: Early movement, guided by therapists, reduces risks of blood clots, pneumonia, and muscle weakness, which are critical in recovery.
- Role of Pain Management: Effective pain management through techniques like nerve blocks can help patients participate actively in their rehabilitation.
- Fall Prevention as Key: Regular exercise, medication review, and home modifications can help prevent falls, reducing the risk of hip fractures.
- Personalized, Supportive Care: Clear communication, understanding a patient’s cognitive state, and teamwork with family and healthcare providers are vital to a successful rehabilitation journey.
Transcript
Brandy Archie
Welcome to Care Lab.
Emilia Bourland
Welcome everyone. This is gonna be a really, really good episode. I hope, listen, buckle up buttercup. Let's get ready, let's do this. We have here with us Dr. Brittany Lamb. She's back again for another episode. So thank you so much for being here. Brittany, I'll let you, yeah, I'll let you give yourself a little intro here if you don't mind.
Brandy Archie
That's right.
Brandy Archie
Yay!
Brittany Lamb, MD
Thanks for having me.
Brittany Lamb, MD
Yeah, yeah. So just briefly, I'm an ER physician. I also recently started a hospice medical director job. So I'm kind of new to that role. And online, I help people navigate medical decision making on behalf of someone that they care about and are advocating for who's living with dementia. That's what I do.
Emilia Bourland
So what you're saying is you really don't have much going on and you're not a busy person. Yeah.
Brittany Lamb, MD
Yeah.
Brandy Archie
I was just about to say you do all the things actually
Brittany Lamb, MD
I wear a few hats right now and it's working. My husband's still with me so it's okay.
Emilia Bourland
All right, good for him. on the back for both of you. Okay, so it's November. I'm gonna say that we're in full holiday swing at this point, because really and truly, if you go to the Home Depot or the Lowe's where I live, then the holidays start in September anyway. So if we're in November, we're in full holiday swing, I have a question for you both before we jump into the nitty gritty deep dive we're gonna take on.
Brittany Lamb, MD
Mm.
Emilia Bourland
hip fractures and broken hips today. Okay, are you ready for it?
Brittany Lamb, MD
Mm -hmm.
Brandy Archie
Ready.
Emilia Bourland
Okay, this is such a softball actually. What's your favorite Thanksgiving day tradition? What's your favorite?
Brittany Lamb, MD
Go ahead, Brandy.
Brandy Archie
I guess I'll let you pass it because you've already been a guest, but really, we made the guest go first. But I'll go, I will go. Okay, Thanksgiving is pretty much my favorite holiday. So I have lots of traditions around it that I like. My most favorite, I think, is not very surprising. It's like eating. I just like to eat dinner. I like Thanksgiving dinner.
Emilia Bourland
Mm -hmm. Yeah, yeah, we're usually rude like that.
Brittany Lamb, MD
I was gonna say your first.
Brittany Lamb, MD
Mm.
Brandy Archie
and I like all the things about it. And I make some of those dishes at other times during the year, but this is the time I get to eat all my favorite dishes at one time. Gluttonous, I know, but it's awesome.
Brittany Lamb, MD
Mm.
Emilia Bourland
Do you have a favorite dish? Maybe that should have been the question to begin with, because obviously, like, we're all going to like the eating part. What's your favorite dish? Mm -hmm.
Brittany Lamb, MD
Yeah.
Brandy Archie
I mean, you could say football, which I also like very close second to watch a lot of football. Like being with my family. You're like, no, not the football. But still it's like the, it's sitting around and breaking bread together, I think with as many people as I can have in one place is awesome to me. And hopping from house to house and seeing even more people. That's like the thing I love the most about it.
Brittany Lamb, MD
No.
You
Brittany Lamb, MD
I love that. Yeah, I'll chime in here. So I mean, my favorite dish is stuffing. And my husband and I argue about the stuffing versus the dressing and the stuffing, the stuffing. My grandmother's stuffing is the best. That's the best part of Thanksgiving. When I have to work in the ER, they save some for me so I can have some. So yeah, that's my favorite, my favorite dish. And I would just second like being able to sit at a table with extended family and like have everybody all.
Emilia Bourland
You're up, Brittany.
Emilia Bourland
Mmm.
Brandy Archie
Mm -hmm.
Brandy Archie
believe you need to say them out loud again.
Brittany Lamb, MD
place, like when that actually is able to happen, it's very special and something I look forward to and feel very grateful for when it actually works out.
Emilia Bourland
and Linus, what, what is, what is the argument about the dressing versus the stuffing? I want to, I want to know this.
Brittany Lamb, MD
well, I mean, it's I mean, which is better, which tastes better, right? So, I mean, I don't know if everybody knows the difference between stuffing and dressing, but like stuffing is bread, creme base and, and dressing is cornbread based. And so I feel like it's almost like a North versus South argument. And so it's just based on taste and preference and the stuffing is better.
Emilia Bourland
Mmm.
Emilia Bourland
So that's really interesting in my family, we define dressing as it's like stuffing, but it's cooked outside the bird. So it's never inside the bird. And like that's a dressing versus like stuffing is whatever is in the bird. And I just like bread. I just like carbs of any form. I love carbs of all kinds. So I like zero judgment. Give me any of it and then I'll put some gravy on top and you know.
Brandy Archie
you
Brandy Archie
Carbs of all kind. Let's go.
Emilia Bourland
All the goodness.
Brittany Lamb, MD
Maybe that's where stuffing actually, huh? You're gonna round it out, okay.
Brandy Archie
I'm gonna round this out. I said I'm gonna round these things out because I agree, stuffing is inside the bird, dressing is outside the bird. However, it's all made out of cornbread, ma 'am. So we only do cornbread. We only do cornbread. It's all cornbread stuffing.
Brittany Lamb, MD
Mmm.
Emilia Bourland
Mmm.
Emilia Bourland
no! No, no, my grandma's dressing, which is the best, is made out of sourdough.
So good.
Brandy Archie
I said what I said. It needs to be made from cornbread. I'm sorry to your grandma.
Brittany Lamb, MD
We're divided here. I guess I like stuffing and dressing because I'll eat it if it comes from the bird or around it, but it's got to be bread crumb based.
Brandy Archie
But it's gotta be bright, come brace. That's what saying.
Emilia Bourland
But you're, so you're, you say no to the cornbread. Brandy says, only cornbread. I say I'll eat anything, but my grandma's is the best and it's made with sourdough. So there you have it. Everyone has their own way. I think other than eating, my favorite thing about Thanksgiving is,
Brittany Lamb, MD
Mm -hmm.
Brittany Lamb, MD
There you have it.
Brandy Archie
There you have it.
Emilia Bourland
that it's like a gratitude based holiday instead of and like a togetherness holiday. mean, the best part of any holiday is really truly just being with the people that you love and care about. And like, you know, the family that you choose, whoever that is, that's the best part. But what I love about Thanksgiving is like, that's really what it's dedicated to wholly is, is that gratitude and giving thanks and being with each other versus kind of get it, you know, it's
You get distracted on other like, obviously, Christmas, we got a lot of gifts and, you know, actually, I love Halloween. I've got nothing, nothing bad to say about Halloween. I love it all. Maybe a little distracted by candy, but I mean, what are you going to? I mean, it's Halloween. What are you going to do? But it's just this day where we're really just being thankful for things and kind of an opportunity to reflect and be with each other. And that's that's my favorite thing. But.
Brittany Lamb, MD
Mm.
Brittany Lamb, MD
Yeah
Brandy Archie
income or something that your mental health has to pay for your finances.
Emilia Bourland
agree. It's one of the greatest, if not, if not the best, holiday. In my opinion.
Brandy Archie
I'm one more than my words amount to.
Emilia Bourland
Okay. We're really gonna, we're really.
Brandy Archie
So what are we really going to talk about? So that we can maybe get back on the same page because I feel like we're very divided right now.
Emilia Bourland
Yeah, we are, this has gotten contentious people. No, so what we're really gonna talk about today is actually like, this is a pretty intense subject to talk about actually. And that is, we're gonna talk about hip fractures, also known as broken hips, a fracture and a bone that's broken, same thing. Same thing. And we're gonna talk about why it is that they can often be so.
Brittany Lamb, MD
Ehh... Ehh -heh -heh -heh
Brandy Archie
Ha
Emilia Bourland
devastating. for example, you know, it's very easy. You can look up statistics on on hip fractures and the outcomes for these things all the time. And we all know that people within one year of having a hip fracture can often have a very high mortality rate. So I think, you know, one of the statistics that out there that's out there is let me I'm a look at it exactly right now. So I don't misspeak. And this is from the Journal of
Brandy Archie
Get it right.
Emilia Bourland
orthopedic surgery and research, the cumulative mortality after hip fracture within one year ranges between 20 and 40%. And the rates are higher in those mortality rates are higher in men than they are in women. if you think about it, yeah.
Brandy Archie
Wait, means, let's break that down. That means that within a year of having a hip fracture and getting it fixed, up to 40 % of people are passed away by then. Like that is very like jaw dropping if you didn't already know that. So that's why it's such an important topic to talk about.
Emilia Bourland
Yes.
Brittany Lamb, MD
Thank
Emilia Bourland
Yeah, and here's what I think is on face value, that seems insane, right? Because a hip does not pump our blood. It doesn't oxygenate our blood. It's not responsible for getting nutrition anywhere, right? But this particular thing, if it gets broken, has these huge, huge consequences. So I wanted to talk a little bit about why that is to put out some good education on this topic and help.
hopefully help some people either prevent this or get through it in a way where they're going to have a better outcome. Because good outcomes are obviously really possible with this. So Brittany, Dr. Lam, let's start with you. What happens when someone comes into the hospital, they have a hip fracture, what's the first kind of medical thing that happens for that person?
Brittany Lamb, MD
Yeah, I mean, I'd just like to say, I mean, it is pretty common. It's a broken bone that we see quite often, especially as people are aging, people have low bone density, people who have even simple falls that other people would bounce back from can cause hip fracture. So, but when people come in, they almost always come in by ambulance. They're not able to put weight on that leg. They're in a lot of pain usually.
People who are very advanced age or maybe living with dementia are super frail. It may be a little bit harder to figure out that they've actually, that they actually have an injury. But oftentimes you can tell on physical exams or we're looking at their legs and one leg looks shorter. That's something that we sometimes will notice. But we get x -rays, we treat pain and then we call, you know, we call it orthopedic surgery. And then the other thing I'll say too is that we do try to,
figure out why the person may have fallen sometimes. Sometimes it's not a very easy, we call it a non -sinkable, non -passing out reason why they fell. And so sometimes it's a medical reason why people fell. And so we have to take care of that as well. But I think the big things are getting x -rays and then treating this person's pain. And obviously treating pain can be risky and we have to do things differently with some different people.
And one of the things that you all can ask for or be aware of is that nerve blocks are a potential modality for treating pain in this, in people with fractures. So, especially if they're aging. So that's all I'll say right now.
Emilia Bourland
What would be, because I actually think that's important not to dive like too far down this rabbit hole, but what's the difference between a nerve block versus other types of pain management that people might traditionally kind of receive?
Brittany Lamb, MD
Mm.
Brittany Lamb, MD
Yeah, yeah. So nerve blocks, you're actually injecting a medication that can make it so that that person doesn't feel pain in that area, like a regional block. So it's making it so they don't feel the pain based on an injection of medication, like a numbing medicine. And then pain medications, we typically are using things like narcotics. So we use morphine, fentanyl, Dilaudid, IV medications.
Usually in the beginning we use IV medications, then sometimes we will give people pills and the ER, but that's not as common. Usually that happens when they get into the hospital, but those medications have side effects, right? They work in your brain, they cause sedation. They really are designed to make you careless that you're hurting. So that's what they do. So they work in the brain, so they lower blood pressure, they can affect people's breathing. And so depending on whatever medical problems this person has and how small they are and...
what their mobility is like at baseline. Like some of these medications, it can be really, really hard to keep someone comfortable with narcotics while also appropriately treating their pain and not causing them further harm. these regional blocks that typically like where I work, the ER doctors don't do this as often because we're really busy and some ERs, they might actually do this. And sometimes they'll call in anesthesia or like a pain team.
Sometimes in the ER, but oftentimes that actually happens too when people get admitted.
Emilia Bourland
Okay, really, really good information to know to kind of understand like the difference between those things and how you might ask questions and advocate for either yourself or someone maybe that you are caring for who is in this situation. Good info to keep in your back pocket for sure. So, okay, so let's move forward in the process. Say we've got this person, they're stabilized, we've managed their pain, ortho has been called.
And let's assume in most circumstances, and this is something that you were saying even before we started recording here, Dr. Lam is that most of the time people are gonna go ahead and have that hip surgically repaired, whether that's through a hip replacement or something that we call open reduction internal fixation, which is where we put like different kinds of hardware in there to hold things together. we've had this done.
What are then some of the medical concerns at that point?
Brittany Lamb, MD
Yeah, so I mean, the biggest thing is what y 'all do is like rehabbing the person so that they can get better and get back to their functional baseline. But complications after hip fracture repair, a lot of it is going to depend on the person's underlying medical issues. So we always have to consider that. But there's always a risk of infection. There's a pretty big risk of clots. That's something I see pretty commonly clots in the legs.
blood clots in the legs, blood clots that can then go to the lungs. There's also a risk of pneumonia in people because they're immobilized, they're not moving around as well. They're oftentimes on pain medications. Those are some of the big things. Infection, bleeding sometimes, like we have some bleeding complications that can happen, blood clots in vessels, and then...
And then infections. So infections because of poor mobility. So urinary tract infections, pneumonia, infections at the surgical site. I'm just completely riffing here. You guys know this too. So fill me in if there are any other things I'm missing there.
Emilia Bourland
Yeah
Brandy Archie
Well, I have a question. Is it more common to have blood clots after having a hip fracture or you're saying in general, after having a surgery, these are three things that are things that might cause additional problems. I guess what I'm wanting to get down to is like, people break their arm all the time. We don't have 40 % mortality. So what is it that's like, what may be some of it? Cause if we knew all the answers, we wouldn't have this level of mortality, but like what may be some of the answers there.
Brittany Lamb, MD
okay.
Brittany Lamb, MD
Yeah.
Brittany Lamb, MD
Yeah.
Brittany Lamb, MD
Yeah, I mean, it's such a it's a huge weight bearing bone, you know, so like people don't move and you can move you can still move your body around when you have a fracture in your arm, you know, so it's because of the impacts on mobility that are really the the main the main driver. I mean, this is not it's not what I do. This is just what I what I see, you know what I see in the ER. So I don't study this. I'm not orthopedic surgeon, but
But yeah, they're devastating injuries because they really impact a person's mobility. And to directly answer your question too, like any lower extremity surgery that somebody has increases their risk of having a blood clot. But people don't tend to get blood clots as often in their upper extremities when they have fractures and surgeries. It's just less common.
Because you know, you can still move your arms better than you can move a leg that's been operated on.
Emilia Bourland
Well, and basically what happens, like the reason there's, and correct me if I'm wrong here, but the reason that there's an increased risk of blood clots forming when something isn't moving is because that blood isn't moving as much or as quickly through that space. And when blood is going slowly, it's then more likely to clot, essentially. Is that right?
Brittany Lamb, MD
Yeah, yeah, yeah. the veins that bring the blood back to the lungs so that we can put oxygen in it. In the legs, there's gravity. So the blood's pooling because of gravity because legs are hanging down. So they have to fight. The blood has to fight against that. And then when there's poor mobility, there's decreased return also because part of the way veins work is they get blood moved because the muscles are pumping against the...
Brandy Archie
50 -30 -20. We broke the ice, bud.
Brittany Lamb, MD
against the veins and helping the blood get back up through the valves of veins. So your muscles moving around your veins is part of how you get blood returned back to the heart. So it's harder for the lower extremities, the legs.
Brandy Archie
So all those ankle pumps that therapists are recommending and you feel like it's not very hard, so it's not very important, this is the reason. Because every time you do this motion with your foot, your calf muscle squeezes the veins and it brings the blood and everything else back up there so we don't have so much swelling and so we don't have blood clots and like that's the purpose of that. I think...
One of the things that I think sometimes we as healthcare professionals don't do a great job of is explaining to people the why behind what we're asking them to do. And then you don't have the why, then you're like, I don't feel like doing this. It don't seem that important. I'm not doing it. I mean, I'm not saying that everybody's just like so blatantly like whatever. I don't care what they say, but like you're in pain, you're tired, you're in the hospital, whatever. Like all these other, you're not having your best day. So.
Brittany Lamb, MD
Mmm.
Brandy Archie
doing all this extra stuff that you didn't used to have to do doesn't always seem so appealing, but that's like the big reason.
Emilia Bourland
Yeah, and so that's really one of the most important reasons. if you have ever broken hip, if you've been in a situation where someone you love broke a hip, one of the things that you probably noticed was that almost as soon as your loved one is out of surgery, there's a therapist in the room there and we're asking that person to get up out of that bed and go walk around or at least get up to the chair.
And it's because we know that the more we, the more quickly we get some, someone mobilized, the more we are, of course, getting them stronger and making it so that they can, you know, live their life again. But right there in that immediate moment, we are also doing things like preventing those blood clots from forming. We're helping to prevent wounds from forming because you're not moving around as much. We're helping to prevent even things like constipation.
Laying in bed, especially if you've got pain meds on board, is really bad for your bowels, right? One of the ways that we work, your body's meant to operate with gravity pushing from top to bottom, right? And so, and that includes how our heart works, how our lungs work, and how our bowels work. And so we've got one of the most important things that we're looking at too is let's get you up, let's go to the bathroom, let's get all of these things moving.
Brittany Lamb, MD
Mmm.
Brittany Lamb, MD
Mm -hmm.
Emilia Bourland
get you positioned in this upright position where we're moving around so that we're working with the way that your body naturally wants to function in order to prevent these bad things from happening.
Brittany Lamb, MD
You
Brittany Lamb, MD
Well said.
Brandy Archie
So, okay, in this kind of journey we're going through, we've made it through, we went to the ER after the fracture, we stabilized it. Okay, now we got admitted, it's gotten fixed. We've hit our first kind of juncture of where there's risk, infection, pneumonia, all the things that you mentioned already. But the mortality issue is not just like at hospital level, it's for a year out. So then what are our other risk factors that are happening maybe?
Emilia Bourland
Mm
Brandy Archie
after we leave acute care that could impact your life expectancy.
Brittany Lamb, MD
Yeah, I mean, I think it's part of what this person was like beforehand and then where they're going to afterwards and what their journey looks like the next several weeks after they have a hip fracture. I mean, y 'all, you guys speak to that too, like, because I see people after they, when they have complications. So I see all the outliers, you know, and I see that people who have high, you know, high mortality.
But I think so much of it is like what this person was like at baseline, like what age were they? Did they already have cognitive issues? Are they gonna be able to engage in rehabbing and understanding, you know, what, are they gonna actually get up? Are they gonna be afraid of falling? And then do they have other problems that would make them at higher risk of having these complications? Like do they have underlying immune, immunode, or immune suppression issues like?
or are they living with congestive heart failure? Do they have COPD? So it's a very individualized thing. The older someone is, less mobile they are, the more cognitive issues they have, and the more medical problems they have. That's all gonna impact their ability to rehab and recover.
Emilia Bourland
So Brandi, I have a question for you.
Brandy Archie
Okay.
Emilia Bourland
So, you know, obviously, all the things that Brittany was just talking about in terms of like, there's, of course, are very straightforward patients that we might see who maybe they're younger, maybe they don't have any cognitive impairment, they're motivated to get up out and out of bed, their pain is well controlled. Like these are relatively simple and easier, they're easier scenarios to help rehab, right?
Brandy Archie
Mm
Emilia Bourland
the path to success is more clear there and it's easier to get there. But a lot of times, of course, we are also working with people who do have underlying cognitive issues, whose pain are not well managed. Maybe they weren't as mobile as they could have been before. Perhaps they are very medically complicated. So what kinds of like tips or tricks have you seen or have you used to help?
Brandy Archie
So reminders, you can stay up door.
Emilia Bourland
to help work with those people and help them, I don't always know that motivation is the right word necessarily, but help them break through those barriers in order to start get up, start moving so that they can see that kind of like better outcome, not just in the short term, but hopefully in the longer term as well.
Brandy Archie
I think I'm going to say what I already said again, actually. The very first and most important thing that I think works the best is telling the why behind this. Because nobody wants to do any of this. They didn't want to break their hip. They don't want to be in rehab. They don't want to get out of the bed. Nobody wants to do any of this, right? They do want to be better and they do want to be alive, right? And so if I can talk to, this is why it's really important that yes, you just got out of surgery and yes, I'm here to help you get up out of the bed because all these other cascading effects happen.
Brittany Lamb, MD
you
Brandy Archie
And so we're not going to solve all of that in one day, but we are going to be able to take a couple of steps in one day. And I feel like that, like you said, motivation is not necessarily the right word. It's just like the ability to overcome all the other obstacles that are already in front of you for the longer term vision of getting back to your mobility, I think is the number one. But then the number two is like, that's only if you're cognitively capable of understanding that reasoning, right? And then if you're not,
and the memory is impaired or whatever issue is going on, I think it's about community. And so that community might be your family that's there supporting you. It might be the other nursing staff. It might be other therapists and us working together to make sure that no matter what therapy they're in in skilled nursing, that we're all working towards similar goals, using same words and doing things that we know works well with the person so that they can keep the ball rolling.
It's all about all the other people that are around you, think, and getting them all on the same page to be the most support in whatever form is necessary, because it is very individual for that person so they can keep moving.
Brittany Lamb, MD
Mm -hmm.
Emilia Bourland
Yeah, I have to really agree with all that. think that education is the foundation of any good intervention period is that if we don't tell people what we're doing and why we're doing it, it's very hard to get buy -in. And ultimately, if you don't have buy -in in a process, for anything medical, but particularly if we're talking about therapy, if we're talking about rehab, we don't have magic solutions. There's not a pill that you're going to take that's going to get you from here to here. It's just work.
Brittany Lamb, MD
Hmm.
Emilia Bourland
So education is foundational to how we get people invested in doing the work. And then kind of also building off your point, like, we're not going to go out there and run a marathon today. We're going to take two steps today. But seeing how each of these incremental wins and knowing that it is a process, it's going to take time. It's going to take longer than you want it to. But if you just keep
Brittany Lamb, MD
Mm -hmm.
Emilia Bourland
moving forward a little bit every single day, then you can get there and that you have a whole team of people around you who's gonna help you. Like no one in this process or in this situation should ever feel like they're alone, like they don't have a partner, like they don't have anyone on their side. Like no, you should be, if you are in rehab, you're surrounded by a team of people who are all pulling for you.
And so how do we all figure out how to communicate well, work together, get on the same page about things and think then we can support some really, really strong outcomes. And then I think what I would add to what you said in terms of we're working with people who have dementia or other kinds of cognitive impairment or whatever it is, you know, how are we, we can't change that person. What we have to do is think about how we as a team or we as individual providers are
working with and approaching that person in order to make sure that their moment to moment experience, because they are probably living in a moment to moment timeframe, right? So what can we do to make sure that their moment to moment experience is as positive as possible, even if it's not always pleasant, right? Like if I'm helping you get up and you're hurting, it might hurt.
And sometimes there's nothing, there's not a whole lot that I can do to take all of that pain away. But how can I still make you feel, how can I make this person feel supported? How can I make them feel cared for? How can I make them feel like I'm not here to torture with you? Like this is something that we're doing together. And that I think is something that we can do even if someone has dementia or they have other cognitive impairments that make it difficult to understand like the big picture of what's going on.
you know, really focusing on creating a lot of positive experiences for them moment to moment and really working together as a team to make sure everyone's on the same page about that, how that happens. Because, and I'll say, I don't know what the research on this is, I don't. But I do think that even if we don't have like explicit memories of things and even if people who have dementia or other memory problems aren't laying down new explicit memories,
Emilia Bourland
I think that experiences make an impact and that those experiences, if they're positive or they're traumatic, can leave an impact on that person, even if they're not consciously aware of it. So I think that sometimes we have to do a better job as a healthcare team and a healthcare system to make sure that we are creating those positive experiences as opposed to, you know, as opposed to
unintentionally sometimes creating traumatic experiences for folks.
Brittany Lamb, MD
Yeah, I think that's really, really key right there. I think sometimes it's too, it's just, I think we get so used to taking care of people who are cognitively normal or able to interact with us that we forget how much slower or how different or how we might need to think outside of the box for people who are living with dementia. And like using all of what we know about this person as a human, remembering who they are as a human. Sometimes that connection can help, you know, get people to
participate more using their family and friends like in whatever creative ways we can. Yeah, and that's really, that's really powerful what you said.
Brandy Archie
And I think that those are like the things that we could do in our best case scenario, right? We talked about like communication and motivation and education and all the chins at the end. like part of my education sometimes depending on the person's personality is telling them how horrible it could be if you don't do this, right? And so, okay, now I'm putting it to you, Dr. Lam. So let's say we pick the worst case scenario. you.
Brittany Lamb, MD
Yeah
Emilia Bourland
Yeah
Brittany Lamb, MD
Thank
Brittany Lamb, MD
Mm.
Brandy Archie
Y 'all did the right thing. Everybody did all the things they could do at the acute level. It's fixed technically, but because it's a hip and it's so painful and it controls, you don't go anywhere without your hip. So it controls whether you're moving or not moving. So say we can't move or we can't move, but don't want to move, or I feel like we're in too much pain to move and we're just like not escalating at the rate that we should. What are some additional complications that might happen at home?
or things that could happen after having a hip fracture that might send them back to see you in the ER.
Brittany Lamb, MD
Yeah, I mean, I feel like I feel I see a lot of times people who haven't moved to then fall again. That's something I see pretty often, especially if people who don't want to go to rehab or they like they, you know, they leave early, they're upset, which not all rehab places are have a wonderful reputation, which is like a whole nother thing. So but I feel like another fall, but I feel
mean, clots are like a big thing that I see, like when people don't lay around, they get clots. then, I mean, I can't remember actually the last time I resuscitated someone from a pulmonary embolism who was after a hip fracture. I don't think I've had anybody that like was coding in the ER from it, but I've diagnosed lots of pulmonary embolisms, blood clots in the lungs. And then if they're big, that puts stress on the heart, it can cause heart damage. And so then like, you can have this just cascade of just...
the person not recovering and you know, and it's usually not just one thing, right? It's like multiple things that add up, like all these little medical things that add up and then they make it so something happens that just tips the scales and you know, maybe it's infection, maybe it's a bigger blood clot and you know, people, a lot of times we put people, up transitioning people to comfort care because they're just like, they're just not doing well and that would be what their wishes were, so.
Yeah, it's tough, but I think clots are a big, big deal and then fall like other falls when people just like aren't moving around.
Emilia Bourland
And so a lot of this just comes, it comes down to like that, that seemingly basic thing of mobility. That when we don't move, then it can cause this series of kind of like cascading catastrophic failures until, until things are really, really not going well for a person. So moral, moral of the story here is we have to get up and move. We, we just, body's made to move.
Brittany Lamb, MD
Mm.
Brittany Lamb, MD
Mm.
Brandy Archie
Our bodies are made to move. Our bodies are made to move. They function because we move. We don't move because we feel good. We function because we move. And so that's why it's so important that we move even a little bit, like just a little bit more each time, right? Cause our bodies are made for that. And nothing works well if you don't do it.
Emilia Bourland
Mm -hmm.
Brittany Lamb, MD
Yeah.
Brittany Lamb, MD
Mm
Emilia Bourland
Yeah, nothing works well if you don't do it. Sorry, go ahead.
Brittany Lamb, MD
Yeah.
Brittany Lamb, MD
yeah, think, and I think also like just to plug prevention here, you know, like we all do, it's like pay attention as you're aging to going to see the doctor, doing your like bone density and like continue to do weight bearing exercises and don't ignore that, you know, it hurts, like it hurts to break a bone, it's uncomfortable.
And who knows if you fall and you break your hip? Listen, I've seen people that have broken their wrists at the same time, broken ribs at the same time. So now you don't just have one injury you're trying to rehab, you're also trying to recover from these other things, which can make it more complicated. So it's like, don't ignore that and advocate for working with you all. Anytime we're worried about someone who's at increased risk of falling, that we do whatever possible in their environment to decrease that risk and to increase their mobility and their functional.
Ability so prevention is key here, but it won't always happen. These things are extremely common
Brandy Archie
Yeah, and that's like why there's such a big, I don't know, I feel like when I encounter clients, I was like, keep from falling, prevent from falling, da da da. But like, it's not made up out of nothing. And it's not just about getting dings from Medicare at a hospital level of falling. It's really more about the outcomes are, like what you said, like you fell and had a hip fracture. And then the main reason you see people come back is because they fell again, right? And so like, if we could have prevented the first fall in the first place.
Brittany Lamb, MD
Yeah.
Mm -hmm.
Hello.
Brittany Lamb, MD
and
Brandy Archie
we might not have had any of those cascading effects, right? And that's why like prevention is so important and like thinking about thinking through the ways to the multiple ways to decrease falls that there are.
Brittany Lamb, MD
and medications. Look at the medications. Make sure you're not being over -medicated because that can cause falls too, especially for people who are aging. It's like always don't forget the medicines.
Emilia Bourland
Mmm.
Brandy Archie
And we've had a talk on the podcast about deep prescribing and finding ways to have less medication. so if people haven't heard the, I think it's the episode, the first episode we had with Reshma, who's pharmacist. But if they haven't heard that, can you just give people a few little tips about how they can initiate that process of reviewing meds and considering which ones need to go.
Brittany Lamb, MD
Mmm.
Emilia Bourland
Mm -hmm, yeah, yeah, mm -hmm.
Brittany Lamb, MD
Yeah.
Brandy Archie
go off because it probably shouldn't be done the way some people I know do it, which is like, I don't know what this means or what it's for. I'm not taking it.
Brittany Lamb, MD
Yeah, so I think the first thing and it's kind of annoying that is just like gathering all the medications a person's taking and actually coming up with an accurate list of them. And then next to that each medicine, it's like, what is the purpose of this medicine? If we don't know what it is, we need to figure it out. And we need to know what the plan is for each medication a person's taking.
It needs to be serving them a benefit. Like we shouldn't just be taking medicines because we're taking them indefinitely. Like it needs to actually be benefiting a person to take a medicine. So each one needs a purpose, a plan, five or more medicines. And we really need to ask for a medication review. I mean, you can do that without a primary care doctor's visit.
The other thing I would say is be really wary when you go to see different specialists because these days, like the doctors aren't always communicating with each other and their notes don't always communicate. So we can't always see that someone else added on a medicine. like, it's up to us to be the champion of our own health and wellness. We obviously need to draw upon the tools of the medical community and all, like, if we're, need to know what medicines we're taking. We need our own list. Like we need to be the owner.
list, right? Don't trust the computer. And then if you're advocating for another person and you're involved in making their medical decisions, like just like you would protect your own self with medicines, you need to do that for them. Like you need to know everything that they're taking and why they're taking it. So but be wary of people adding on things, also adding on things for symptoms of other problems. So but five or more medicines, and I would say like really, it's time to like make sure that these are all serving a purpose and they're not treating side effects of other things. So
Polypharmacy is like the main, like one of the buzzwords, like it's a real problem. Too many medications basically. And then deprescribing. If somebody doesn't believe in deprescribing, then I don't know. They may not actually care about patients. yeah, that's all I'll say about it. I could talk about that for a long time.
Emilia Bourland
I
Emilia Bourland
So to kind of like, I think we've gone into a lot of different areas for this topic. think hopefully not in too overwhelming a way, but kind of to sum up final thoughts here. First is the best thing to do to avoid the problems that come along with having a hip fracture are to do fall prevention in your own life. And we know we can prevent so many of the falls that occur.
Brittany Lamb, MD
Yeah
Emilia Bourland
through things like medication review for polypharmacy, through things like home modification with an occupational therapist, through things like regular exercise, socializing, engagement in meaningful activities, make sure you get your eyes checked and your glasses updated. Like these are things that we can do that are actionable that we know are incredibly effective to help prevent us.
from having that fall and that hip fracture in the first place. So if you haven't had that, if you're not there yet, like use some of the doom and gloom that we spouted on this episode, cause we spouted a fair amount of it. It is scary. And you know what? If that scares you a little bit and it motivates you to go out and take some preventative action, then great. Use that motivation to go and take care of that now. And on the other hand, if you are in a situation where someone has already fallen,
Maybe they're in that rehab process or maybe that's even you when you're sitting there. Use this as motivation to say like, are there some scary outcomes? Yeah. But do they have to be that way? And the answer is no, absolutely not. You people can and sorry, get moving, get moving. We have great outcomes all the time. You just have to get up and do the work.
Brandy Archie
No, get moving. No, get moving. They don't have to be that. Get moving.
Emilia Bourland
All right, guys, we care lab. We care lab the heck of it. Brandy, take us home.
Brandy Archie
I think we care lab that. Yeah.
Brittany Lamb, MD
You did good.
Brandy Archie
If you made it all the way to the end of this episode, we are grateful for you. And we'll be even more grateful if you leave us a review and us too on the Polyclass platform or YouTube where you're watching or listening to this because then other people who need to hear this message can get that as well through the algorithm. So like and review us and then leave us a comment because we always want to answer your questions and CareLab them. So let us know. We love the feedback. And then come back and see the next episode of CareLab next Friday.
Emilia Bourland
Alright, we'll see you next time right here on Care Lab. thank you Dr. Brittany Lamb for being here again. We sure do appreciate you. You're amazing.
Brittany Lamb, MD
Anytime, thanks for having me.
Emilia Bourland
All right, next time guys, bye.
Brandy Archie
Bye.
Brittany Lamb, MD
Bye.
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