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She fell and hit either the toilet or tub. She does not recall. She was released from the hospital within 3 hours. My understanding is that broken ribs are one of the most painful breaks but she doesn’t seem all that bothered. She broke the ribs in back vs. front; does this make a difference? Could her threshold for pain be this high or is there something about the dementia that could be having an effect on her experience of pain? The family present at the time suspected (but cannot confirm) that she fainted before she fell. She briefly fainted once again while waiting to be discharged. Could something else be going on? I understand to be on the lookout for pneumonia as well. Thanks.

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There are no pain receptors in ribs, but often when they break the Intercostal Muscles tear and that is incredibly painful. Back or front does not vary the pain. I have dislocated a rib in my back multiple times and it is excruciating. When I had pneumonia, I coughed so hard I tore my Intercostal Muscles on the front. It took weeks to heal, I could not lift, stretch, even wash or brush my hair without tearing them again.

If may be the dementia has impacted the part of her brain that transmits pain signals.

A couple tips while she heals. Do not let her reach behind her back. Even if it is to pick up the remote from a table slightly to the rear of her. Do not let her pick up anything that may be heavy.

Laying down may be painful, I had to sleep with my head elevated to reduce the pressure on my ribs.
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Grandma last cracked some ribs back when she was a young 101. She wasn't in as much pain as people thought she would be either. The nurses said they'd seen grown men crying like babies with less. They wanted to put her on opiates. She was fine with Tylenol. From day one, she could still get out of bed by herself and do all the things she normally does. A week later, she was much better. Two weeks, it was like it didn't happen.

Once, I cracked a rib when I was sick from all the coughing. It wasn't that bad except when I breathed in. Then it was like I was being stabbed with a knife in the side.
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I guess some people can tolerate it better than others! (That wouldn’t be me...). It sounds like your experiences were awful. She was very physically fit when she was younger and still gets around quite easily. This probably also makes a difference. So, is it better for her to have complete rest or to try to walk around here and there, especially to keep the lungs clear?
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Tothill Feb 2019
Bed rest is not necessary for broken ribs. They will not heal any faster, and as you say staying active is important.
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I found with Mom and her Dementia that the littlest pain she complained about, like a little child. But like said, it could be the Dementia. I suggest you get a blood pressure cuff and check her BP every so often. If really high, she probably is in pain. Her fainting could be low bp. I would bring this to her doctors attention.
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That’s a great suggestion, JoAnn29. Thank you.
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My mother was always in pain--my whole growing up life she never once said she felt "fine" if someone asked her. Seriously, I have ZERO memories of her not saying
"Oh, I have an excruciating migraine" or whatever the pain du jour was. ( And Karma is such that I now have chronic pain that I have to live with forever!)

Now she is almost 90, she takes maybe 1 tylenol for pain. I KNOW that NOW she is in pain, but she doesn't seem to "feel it"? Slight dementia, more just forgetfulness and repeating herself over and over.
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Jannner Feb 2019
My mother is the same. Her entire life a splinter caused a day long dramatic episode 🙄but now, 92, dementia , broke her hip and after hallucinations for 3 weeksfrom the meds, once she was off morphine and the anesthesia was pretty much out of her body, “no pain” she says. Who’d of thunk it 😂 But in reality, I think the pain before was for attention ( definitely narcissistic tendencies) where as now, it’s a more realistic representation of what pain she really feels. Because we are used to her drama, a more normal reaction seems like an under reaction.
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Mother only took 1/2 a pain killer! Tough as nails. I saw chiro today and he said that fracturing the front is much worse than the back just bc of the muscles the individual areas are connected to. Maybe that’s part of it.
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Perhaps the Pain Killers they would Need to Put her On, Is Helping too.
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Yes, my dad has fairly severe frontal lobe temporal dementia. He just does not register pain normally. He does have fairly significant neuropathy and I believe that also contributes but it's difficult to know whether the brain is causing the neuropathy. Dad received a blow to the fore head as a child and had a compound fracture that caused a small abscess on the left frontal lobe of his brain. Earlier in life he compensated for it and I believe it actually gave him more drive than most people have. He somehow had difficulty being aware of other peoples emotions yet he himself was a very feeling person. Now he has moments of clear thought but also confusion. He does not feel pain the way you are I would. So your mother could be going through something similar.
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What type of break? - I have cracked my ribs 3 times & they only hurt when I moved in certain ways or coughed otherwise it was just an ache [I cracked them from coughing so I once used a long line bra to have something to cough against to minimize the pain] - ask her dr as to how much pain she is experiencing to be sure
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Coping1022 Feb 2019
Not sure how to specify the break; “multiple rib fractures” is how it was listed on the discharge papers (I was not at the hospital); it happened out of town. I did get her to hold a pillow around her front so that when she coughs, she minimizes the movement. Thanks for that tip!
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My Mom broke her lower leg and her hip at 88 and never complained about any pain. When the bone in her hip broke, causing her to fall in the bathroom, she told my brother to "just pull it back in place"! With the broken bone in her leg, she was also at my brother's house and he put ice on it and wrapped it but did not take her to the doctor. When it was my turn to have her (we each have her for 3 weeks at a time), I took her to get an xray and found the bone was broken and the orthopod put her in a boot! She had been walking on it for 3 weeks before this. As she says about herself, "I am a tough old bird". But, I do think her cognitive impairment has something to do with not being aware of pain when she should be.
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My mother also felt less pain as her dementia progressed. I broke 6 ribs and my shoulder along with a pelvis at one time. And I can tell you that many broken ribs do hurt! For 4 tp 6 weeks! When my mother broke her pelvis she would forget that it was broken and get up. She would wince, but it didn't stop her. I had a hard time with the rehab place because they would put her walker in the corner. I said leave it by her bed, because she is going to fall without it. They said, "She is supposed to calll us." I said, "She can't remember that she needs to do that." You would think a rehab would understand dementia better than the average person, but no...
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Thank you all for your insights! Interesting experiences. I just found out that the pain did kick in, bc she’s now on prescribed painkillers every 8 hours. She was staying with a relative when it happened but she’ll be back home tomorrow. Then we can assess how she gets around at home.
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What dementia meds is she on? Why did they release her from the hospital so quickly? If she fainted before she fell, did she hit her head? That would be deemed a medical emergency.
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Coping1022 Feb 2019
She’s on two meds...donpezil and one other, that I cannot recall. She’s actually my boyfriend’s mother, but she lives with him so I see her frequently. We were trying to clarify that today (was it fainting or just tiredness bc it was middle of night); it does sound like a fainting spell. She went to the hospital in an ambulance; they happened to release her in just a few hours. She just returned today from her daughter’s home where the accident happened (they live a ways out and she would have had a hard time with the travel), so we’re getting a better idea of how she looks, sounds, etc. She did not complain of any head pain, but the rib area clearly hurts now, even with pain meds. She’s doing her breathing exercises and coughing a wet cough quite a bit; hoping that’s a sign of her lungs trying to stay clear.
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Mmake sure she doesn't have a UTI because it had my mother in a comatosed state on 2 occasions. Sometime the inner ear infection causes that.
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Coping1022 Feb 2019
I’ve seen some bad UTIs with my own mom, but comatose? Wow. I’ll remember that. (Are you saying that a possible ear infection could have caused the initial dizziness?)
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My husband would get hurt badly and not even know he was hurt. This is a very scarey thing to watch happen and to be on the end where you see blood or severe bruising on a loved one and have no idea what happened or what is going on and they can't help you figure it out. My husband did break his back last May and that is the first time I had heard him recognize getting hurt since he had his stroke 15 years ago.
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Oh that has to be terrible! I’m sorry.
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Yes, dementia can affect pain. Depending on how far along she is, sometimes dementia patients can't explain or verbalize what IS actually hurting. Along with UTI's (have never heard of the passing out part. Confused yes.) it could also be blood pressure. Sometimes when my dad stands up too fast he gets very unsteady and starts walking too fast then falls. If she has dementia and was at someone else's place she could have been even more disoriented and turned around and tripped over something. My mother in law wasn't even that far along in her dementia, was visiting us, got up to go to the restroom in the middle of the night and went into the closet instead. Just the slightest thing can throw patients off. Also, blood sugar and potassium can be off. I can't believe the ER turned her loose so quickly. Blood tests and CT's can be done all at once and then you know for sure. Good luck and God Bless...
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Thank you. I am concerned because she is coughing regularly...a raspy, wet cough. I don’t know if that’s a good thing or not (i.e. is the coughing a sign of her lungs working to stay clear or could she be headed for pneumonia)?
She has a follow up with her primary in three days, but I’d rather she be seen sooner than later. She was with her daughter for an extended stay when it happened, who had a cold...I suppose she could have caught the common cold, but with the fractured ribs, I just don’t know. She is spitting up phlehgm, but I do not know what color. So, I guess I’m wondering if coughing like this a positive or negative thing. They say fractured ribs require breathing exercises with a spirometer and coughing. Do they mean intentional coughing vs. what mom’s cough is?
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Coping1022: Okay, but it would be best to monitor your boy friend's mother.
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