Alzheimer's After Surgery

HeartOnSleeve2210

Hello all. Recently, my Grandfather had to have his hip replaced do to a fall. His Alzheimers hadn't been too terrible, mostly worst at evenings. But since the anastesia, it has gotten so much worse. He's not supposed to put any weight on his hip at all for right now, but he forgets that he's had surgery and forgets that he's not supposed to walk anywhere, so at night he often doesn't wake my Grandmother or I up for help if he needs to use the bathroom, and his sleeping habits have gotten worse. My Grandmother is afraid to go to sleep, and there's only so much I can do because I have to work. We did send him to a rehab place when he first fell and broke his hip, but this place was awful and could not acomodate to his needs and he fell four more times and ended up needing to have his entire hip replaced. My Grandmother is so stressed out and frustrated, and I don't know what I can do to help make it better. Does anyone have any suggestions? Will he ever get back to where he was Alzheimer's wise before the surgery or is this a permanent downhill slide?

abc123

I don't know if he will get back to his baseline or not. Some people here have talked about their loved one getting back to their base line after about 4 to 6 weeks. I can tell you from experience if your grand father keeps getting up at night by himself he will fall again. He could possibly break the other hip or the one that was just repaired or both. If he is put under anesthesia again soon, his chances at recovery will be very low. Is hiring a night time sitter possible? How old is he? That makes a big difference, also, how is his overall health? Others will come along with more experience and suggestions. Good luck to all of you.

HeartOnSleeve2210

He's not really up there, he's 78 now. His overall health is great! It's just him getting out of the bed by himself that's hurting things. Then he and my grandmother start arguing, and it all just turns into a whole mess.

M1

Im sorry HOS, unfortunately this is why hip fractures are so often fatal in people with dementia. He needs a sitter if he is to have any chance of recovery. So difficult. I hope you can find one.

dayn2nite2

I doubt very much he will go back to the way he was pre-surgery, but it sounds like there was no choice about whether he needed it or not, and the slide downward will just be part of the process.

harshedbuzz

HeartOnSleeve2210 wrote:

Hello all. Recently, my Grandfather had to have his hip replaced do to a fall. His Alzheimers hadn't been too terrible, mostly worst at evenings. But since the anastesia, it has gotten so much worse.

I am sorry your family is dealing with this issue. We had a very similar scenario with one of my aunts and as M1 mentioned, it was the beginning of the end.

Anesthesia and hospitalization can cause a significant progression in dementia. Often there is an improvement if there was  -only- hospitalization, but there is usually not a return to a previous baseline IME with general anesthesia. It sounds as if he might have had a procedure ahead of the hip replacement- if both required anesthesia I wouldn't expect much improvement over where he is now. 

He's not supposed to put any weight on his hip at all for right now, but he forgets that he's had surgery and forgets that he's not supposed to walk anywhere, so at night he often doesn't wake my Grandmother or I up for help if he needs to use the bathroom, and his sleeping habits have gotten worse. My Grandmother is afraid to go to sleep, and there's only so much I can do because I have to work. We did send him to a rehab place when he first fell and broke his hip, but this place was awful and could not acomodate to his needs and he fell four more times and ended up needing to have his entire hip replaced. 

When we were in this situation, my aunt was already in a AL (which was a bad fit for a lot of reasons) and then turfed to a rehab/SNF after her surgery. She had VD and took a major step down in function which likely led to the initial fall which was followed by hospitalization, surgery and rehab/SNF leaving her several stages beyond where she'd been a month prior. She did not have the cognition to cooperate with her rehab or the post-surgical protocols around weight bearing.

Because it is neither legal nor ethical to physically or chemically restrain a person, the family had to cobble together a sitter schedule even after she was moved into a SNF bed. This was really hard on family. This particular aunt didn't have much in the way of assets, so her daughter, her son's widow and one sister filled in most of the slots 24/7 as there was no other available family left. The sister was already caregiver to another sister with dementia and my mom was 300 miles away and dealing with dad's dementia. 

My Grandmother is so stressed out and frustrated, and I don't know what I can do to help make it better. Does anyone have any suggestions?

The answer is most likely to hire a sitter/aide for overnights to stay up and watch for this behavior so that your grandmother can get a consistent and sufficient sleep. She can't continue as she is for very long without impacting her own health. 

Will he ever get back to where he was Alzheimer's wise before the surgery or is this a permanent downhill slide?

You have probably seen whatever improvements in function you would within a week or two of being home and in a familiar routine.

In my aunt's case, the broken hip and single surgery were not only associated with a permanent decline in function, it hastened disease progression. She passed with about 4 months after her fall. At the time, my dad, favorite aunt and this aunt all had dementia- she was the last one diagnosed and the first to die. I the know you said "his health is great!" but it really isn't, sad to say. Dementia is a progressive and terminal illness.

HB

May flowers

I’m sorry for what you all are going through with your grandfather’s fall and surgery. My FIL had hip surgery in January and did a month of rehab at home during which we were going to gauge if we thought he would be able to get back to where he was physically/cognitively. One nurse told us we should know within a month or two what his new level of ability is.

For now, would your grandmother consider a nighttime caregiver so she can get some sleep?

Physically, he is strong enough but cognitively his ability to walk is gone. The first few weeks he tried to get up and walk as before but now he has no understanding of how to move his feet or keep his balance and will try to sit where there is no chair, etc. He has no confidence in anyone helping him, so he pulls against us and won’t walk with us. At this point I have to wait until I have help to transfer him. The hospital bed with a bed alarm is a godsend for us as he is not able to get over the bed rail. 

It was a good month and a lot of med adjustments but he is sleeping through the night again. That is very hard for your grandmother, I know. Either the anesthesia wearing off or the meds he was on was causing major nighttime delirium. Tamulosin was the worst for him - he was having to pee 10 times a night and wanted to get out of bed. Now he is down to just once a night. For us, the answer was coming off almost all meds - the nighttime combo that works for us is melatonin, Zyrtec, Pepcid AC, and magnesium.

Other abilities that seem to have permanently gone are incontinence, grooming, and feeding himself. He is clearer and more aware now than he was on all the mood/psychotic meds at MC and we see more glimpses of his old self. 

Everyone is different though, and the rehab nurse told me that she has seen maybe half get back to pre surgery levels, so hopefully your grandfather will be one of the lucky ones! It is just a very slow process.

MN Chickadee

I would assume he will stay this way and be pleasantly surprised if he improves some. He may, but it isn't guaranteed at all. Anesthesia can permanently cause decline in a PWD. In the short term I would buy a floor mat alarm. You can put it right next to his bed and you or your grandma will hear the alarm if he stands up so at least you have a shot at getting to him before he falls. But really you need someone awake at night. Is it possible to hire a night time caregiver? Your grandma will burn out very quickly if this continues. Many caregivers die before the PWD because the stress and lack of sleep start to affect their own health. I would make sure that any time you or anyone else are keeping an eye on him she sleep in a different room, try to get as much un-interrupted sleep as possible.  Are there any friends or family you could ask to take a night here and there to allow you and grandma a good night's sleep while you figure out the long term plan? During some points of this disease falls are just inevitable no matter how hard we try. We try our best but it only takes a second to fall. Whether at home or in a facility many PWD go through a phase of many falls.  It is so frustrating and we feel so helpless. I'm sorry you are going through this.

JDancer

Look for an alarm that slides under him and goes off with movement. It would alert someone in the same bed/room that he needs help.

DrinaJGB

My DH had to have emergency hip repair after a fluke fall in the bedroom. It set his brain injury recovery back years. The rehab he was in was a pit. Every morning that I went in to see him he was lying in his bed urine and sometimes feces soaked---and had been that way for hours according to the wet urine stains on his pajama top and tee shirt. After a few mornings of this I had had enough.

 I discharged him home 2 weeks early- (where I had been caring for him since brain injury for a few years)---and had therapy come to the house.I got him up and walking as soon as possible. It was an uphill battle for sure.

 The anesthesia set his recovery back so far I thought it was hopeless. But he slowly got better over time---only to be recently diagnosed with mixed dementia.

Upon visiting his neurologist a year after his surgery, he stated that he was surprised to see DH walking without a walker or cane--that his kind of surgery is likely a death sentence.His doctor asked me first off how the surgery affected him and I said we took several leaps backward. He nodded and stated that is usually the case with a brain injured and/or dementia patient.

  Six years later he is still walking with me every morning with our dogs.He has slowed down, but still walks without assistance. I truly believe that getting him up as soon as he could stand was what saved him.

abc123

Thank you to everyone who commented! I appreciate it. I was way off about returning to baseline. Everyday is truly a learning experience.

nancyj194

Hi Hearton, I am sorry you are going through this with your grandfather. Here is  a thought.

When my husband had his shoulder replaced, he was hooked up to an ice machine and oxygen when he came home five days later. I ordered  a commode for him and put it right by his bed. He actually used it when he got up in the night to urinate.  He was in his 70s at the time and was stage one or two with Alzheimer's,  Now he is 82 and last September he had an emergency appendectomy and was sent home three days later.  During his hospital stay he was confused about where he was and why he was there, but still knew who I was.  I didn't get the commode out during the night when he returned home, as he was able to get up and make to the bathroom.  

As for his mental recovery since the surgery, it came back to where he was before the surgery, but with Alzheimer's there is always a slow but continued progression.  

He does have a small side rail on the bed because when he would get up in the night, he would not turn the light on and kept falling.  Thankfully nothing ever broke but he did have bloody scratches on his face and arms. His reason for not turning on the light was because he didn't want to disturb the dog, who slept with him.  I assured him the dog was wide awake.  Last summer our dog was diagnosed with intestinal lymphoma and was put to sleep on July 7, after chemo made her worse.  So, my husband now turns on the light when he gets up to go to the bathroom at night and no more falls. 

I wish you the best figuring this out.

HeartOnSleeve2210

Thank you everyone for the replies! I really appreciate it! I think my Grandpa is going to be okay, right now he's pretty sharp and full of sass! He's teasing me the way he always did, so hopefully that's a good sign. Thank you!

*Ollie*

It's hard to say.  When my dad had surgery at 80, it catapulted him into dementia and he never recovered.   I feel like the effects of anesthesia on older people with memory issues is a huge problem that is not really talked about when surgery is being discussed.  I had no idea there would be such devastating effects on my dad.  I hope for the best possible outcome for you.