Surgery(1)

HeartOnSleeve2210

Hello, it's been awhile since I posted anything, but just a few days ago my Grandfather with AD fell and broke his hip. he had to have surgery to fix it. I was wondering, if any of your loved ones with AD have had surgery, and did the anastesia make their AD symptoms worse?

Jo C.

Hospital induced delirium is quite common in many our Loved Ones (LOs) when hospitalized; especially following a surgery.  This can be delirium where the person is hyperactive in acting out, etc.; it can also be a hypoactive delirium in which the LO becomes apathetic, and begins to more or less shut down.  Here are two good links to acquaint oneself with delirium.  One is a bit different from the other in suggestions.  NOTE:  Delirium is often missed by many physicians and nursing staff so we must become our LOs advocate:

https://my.clevelandclinic.org/health/diseases/15252-delirium

https://betterhealthwhileaging.net/hospital-delirium-what-to-do/

My step-dad developed hospital induced delirium twice.  The first time it was severely dramatic.  He had moderate Alzheimer's and was doing fairly well prior to his hospitalization; but during the hospital stay he had a very significant downturn in confusion, memory, behaviors became negative, he was tremendously upset.  To make matters more confounding, he was placed in a Skilled Care Rehab after the acute hospital stay - one more change which reinforced his delirium.   He had thank goodness, a really wonderful care aide in his home. She and I decided to get him back home and see if that was workable.  To our surprise, he was much more relaxed when home; behaviors quieted, but he was still confused, etc.  In about two weeks he began to "wake up" from the delirium and return to who he usually was prior the hospital stay.  It took a few more weeks and in about a month or so he was fully recovered.

His second hospital stay did not involve a surgery.  He did develop delirium but not as dramatic as the first time. We had him discharged to home and his recovery from delirium was amazing - he was completely himself in about two days.

This is just one person's story; situations are often different.  I sincerely hope for the best for your dear grandfather; let us know how you are and how it is going, we will be thinking of you.

J.

May flowers

My FIL had hip surgery a month ago, and had to have general anesthesia. What we experienced:

It was very hard to get him to stay awake after surgery. They had to discontinue many of his meds that cause drowsiness to get him “awake” enough to even stand up.

Because he is off of some meds that made him zombie-like, he is actually a little more alert and responsive, but dementia-wise he definitely has gone downhill. Being off the meds he is able to express a little more emotion, and interacts with his environment, like petting the dogs, so that is good.

Prior to surgery, he could walk without a walker, use the toilet, brush his teeth with assistance, feed himself finger foods, and express needs. He cannot walk unassisted now, cannot follow simple directions at all, can only feed himself a few bites. He may start to eat a sandwich then “blank out”. He is very confused He will try to drink from a candle or eat the string on his gown. He can still drink from a cup though. He falls asleep with it in his hands. He has no sense of space or where things are, he will be walking with me and just try to sit, chair or no chair. He is completely incontinent now, does not know how to use the toilet. He is down to maybe 10 words a day. Sometimes he tries to get a thought across but it turns into gibberish. Other times he will say something clear as day and surprise us.

When he sleeps, he cries and talks gibberish and makes repetitive sounds like “he,he,he” or “ah, ah, ah”, and says names if loved ones who have passed. We thought it was anxiety. Working under the doctor’s guidance, we have stopped Ativan, lexapro, and memantine (all very low dose already) and he is sleeping much better.

I had read pre surgery that it can accelerate the decline, so we were sort of prepared. Compared to pre-surgery he is worse, but compared to post surgery he has made some strides. Hopefully he can regain some of that function.

The home health nurse said that it can take a month or more to really recover from anesthesia, and it is gradual. She has seen patients get back to pre-surgery form and others never do. So it is a wait and see.

May flowers

I wrote a longer post, but I realized my LO sounds further along than yours in dementia so I will cut it short and say that in our case (one month post op) , he is not where he was pre-surgery, but he has made progress from where he was post surgery. I do not think he will regain some functions from before.

The delirium is real, especially with general anesthesia. 

The home health nurse says that she has seen some patients get back to pre-surgery level and others had a permanent decline. But all took a good month at least to know for sure.

HeartOnSleeve2210

That's exactly how it is for my Grandfather! He's moved between two hospitals and is now at a rehab facility, and he is extremely confused and often get incredibly agitated with my Grandmother. he likes the place he's in, but he is much more confused than he was before. We'd love to bring him home, but at this place he gets physical therapy for his hip five days a week. We can't provide that at home.

May flowers

We opted to bring my FIL home after his surgery. We had a month of PT/OT visits, so he had four days a week of help. They told me what to do with him - but it worked because I am home already and DH has a flexible schedule, plus it does require some strength. I injured my rotator cuff with his pulling away when walking so it’s no cakewalk, lol. We considered rehab, but we heard stories about the ones locally not being good for severe dementia patients, because they weren’t good with making sure they were eating, drinking, etc., like they would in a good MC. It is good that your grandfather likes it there.

Either way, the confusion is normal. My FIL was at a whole new level of confusion - but he is coming around. He is starting to grasp who we are again - and engaging more with us so things are improving. It takes time.

LEMitch

Hello,

This is my first post but I've read numerous posts and this appears to be a very helpful group.

My mother has dementia and a mengionoma(sp). We have to decide if she's going to have surgery or just leave it alone. She's 80yrs old and our concern is her recovery. I care for her by myself and work M-F.  Does anyone have any pros and cons of your LO having surgery with all these variables?  She already has outbursts and gets agitated easily. I think with surgery this could be disastrous!

Stuck in the middle

Welcome aboard, Mitch.

I don't know what to tell you about the surgery without knowing where the tumor is and the prognosis if untreated.  My first thought is to avoid surgery (anesthetic) and think the dementia will probably put an end to her problems before the tumor.  Is it causing symptoms?

You can start your own thread by clicking the green "add topic" button near the top of the page.  More people, some of them medical professionals (I am not) will see your post if you do.

LEMitch

Thank you for the suggestion of starting a new thread.