So after 3 weeks in his new digs at assisted living where dad got continually worse, he ended up with being 911 to the hospital who then transferred him to another hospital. He had lived fine, even improving over the past year despite a subdural hematoma. When discovered, the doctor at the time was unconcerned. But it must have started bleeding again and caused a fall or vice versa. The hospital said he was dehydrated as well (so assisted living wasn’t pushing the liquid enough). Anyway. His dementia is worse (likely due to the hematoma) and his balance is off and he’s weakened a lot. But no pain. They want to do surgery which will give him at least two weeks of pain and suffering and of course being in bed so much will require rehab. He already has another heart issue and he and the doctor and I have decided not to put him through another heart procedure, even just a stent ( but the doc thinks it’s another valve). Dad didn’t recover from his other valve surgery 2 years ago which is when the dementia started as well. My question is whether anyone this age sees dramatic improvement from this hematoma surgery?
If he had been perfectly healthy prior to this I might think about it but with a diagnosis of dementia, heart issues I would not consider it.
With dementia rehab is difficult
With dementia surgery (anesthesia) is difficult. Takes a long time to come back to pre-surgical cognition, if they do.
I do need to say something about ALs. They are just that, they assist. Mom's did monitor her weight and her meds. But they are residents not patients. They are living independently with some help. Most stay in their own rooms and just come out for meals. Its up to them or family to make sure they have enough water in their rooms. ALs do not have the staff to monitor liquid intake. ALs are not skilled nursing.
Now Moms LTC did have an aide come around every so often and put fresh ice water on the residents bed tables. I noted too, that if they were out in the Common area that cups of water were given. But this is skilled nursing. Maybe Dad needs a higher level of care at this point.
Only you can make this decision. But this is going from bad to worse. This is apparently a complicated bleed. If the doctor is being honest with you he will be giving you the odds of how likely your dad is to survive, or survive intact. I would say that they are very small.
Most Assisted Living Facilities don't monitor hydration. Most elders enter the hospital with dehydration at BEST because as we age our drive to recognize when we need fluids is lost. Your Dad may have been in the wrong level of care, though I suspect with a bleed this would have happened in any case. The low BP may have even helped oddly enough, as lots of fluids on board raises the BP and would worsen any bleed in the brain.
I certainly do wish you the best. Only you can decide this with the doctor's input. Myself, as a retired RN, I would never do anything other than the simple burr hole to relieve some pressure, if that. I am so sorry for all the complications. I know you already recognize that this isn't going well, and any efforts are last ditch efforts. I hope you will update us how things are proceeding.
We let the doctor throw himself under the bus by being the one to tell her she could not have the surgery. SO she's mad, but at somebody NOT in the family.
IF this procedure greatly improves dad's overall health--you could try. But anything with general anesthesia--and with the brain--you could have an outcome where, yes, the bleed is contained, but dad loses more QOL.
Sounds like he can't make his own decisions. I personally wouldn't sign off on a surgery like this for mother.
Who knows if he will recover to have some quality of life or not? Still glad I did it so that he has a chance to try. He is not in ANY pain but i don't know if that's only because he's only a day off anesthesia. He's tired of being in bed etc.
This last week we were going day by day and he was doing worse and worse and the nurses were all dropping little comments about how a 93 year old with dementia shouldn't have burrhole surgery. I nearly cancelled it because it seemed his brain was further damaged. But he's still in there and I know he will work on getting better if we can only keep him nourished. Feeding intravenously isn't something we can keep doing for long... and the nose tube wasn't an option because they were seeing him pull all tubes out when he was agitated.
Anyway, just thought I'd tell you that we are glad we tried this and hopeful that he will get back to where he was before the fall.