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I believe my mother may have had a fall at some point. She started complaining of lower back and hip pain. X-rays were done. They found five compression fractures in her back. Mother is 85 and has been living in memory care for the last two years. She’s probably mid to late stage of dementia. They found a pulmonary embolism, pulmonary hypertension, about six months ago. They recommended hospice at the time which she is now on. She is in a lot of pain, they say my options are possibly surgery, however, with the pulmonary issues, not sure any surgeon would do it, or pain management. She is in so much pain. I just don’t know what to do for at this point. Any, and all advice would be appreciated.

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Anesthesia will likely worsen her dementia. You need to find out if the kind of surgery they are proposing can be done with a local and not general anesthesia.
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First off, if your mother is now under hospice care, surgery won't be an option with them unless you want to go off their care and then back on it afterwards. But I don't believe at this point it would be worth it because if your mom is under hospice care it is believed that she will be dead in 6 months anyway so why would you put her through even more pain caused by the surgery itself? Plus like already said any surgery in the elderly(especially those with dementia)will make their mental decline even worse from the anesthesia.
Instead talk to hospice about providing your mother with some heavy duty pain medication(they usually start with morphine)as their purpose is to keep a patient comfortable and pain free until they die.

Also with vascular dementia, falling a lot is one of the many and early symptoms of it, so it doesn't surprise me that she has some broken bones.
My late husband who also had vascular dementia fell a lot. As in A LOT.
And because vascular dementia is the most aggressive dementia with a life expectancy of only 5 years, I certainly wouldn't put your mother through any more than you absolutely have to.
I wish you both well, and your mother peace as she takes her final journey.
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Is this the surgery they are recommending?:

kyphoplasty: a minimally invasive procedure used to treat vertebral compression fractures by inflating a balloon to restore bone height then injecting bone cement into the vertebral body. kyphosis: abnormal curve of the thoracic spine, also called hunchback.
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Thank you for everyone who responded I really do appreciate it. My first instinct was to try to manage it with pain medication, I really don’t want to put her through anything else. However, hearing your thoughts helps reaffirm my initial reaction.
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85 and surgery? I think better not. Back surgery can go terribly wrong. Also, recovery time from back surgery is VERY long.

Speak with doctors. Ask for their HONEST opinion. Ask what they would do, if it were their mom.

5 compression fractures are a lot. When did she maybe fall? Months ago? Days ago?

The compression fractures WILL heal naturally, but it’ll take at least 3 months. Don’t use a back brace. That’ll make your mom weaker.

An elderly friend of mine had 1 compression fracture. 6 months later, finally the pain subsided. He just went on with life as normal, waiting for the bones to heal. No pain medicine. He tries to avoid medicine.

Your mom has 5 compression fractures. Keep in mind that painkillers will weaken her muscles, so she might fall again.

You can explain to your mom, that several months from now, the pain will subside.
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