What are the concerns involving a person with dementia undergoing surgery?

cwillie posted you to a link that will take you to the most common problem we see posted, that being problems due to anesthesia. This is something that during my long nursing career I saw over and over again, and that MDs denied.
As I never saw the patients after hospitalization I never knew whether or not the patient improved once in home environment.
Let alone anesthesia or NO, we do see often that a person with some level of dementia becomes very much worse in hospitalization, or in any change of their habitual norm.
You have then also a debilitated and ill elder who is exposed to everything from very bad nosocomial infections such as pneumonia, other bacteria that are resistant to antibiotics, and you have a recipe for disaster right there.
Now add on that nutrition and healing is worse in the elderly, skin is at risk, and blood clot disorders are often lethal?
You are truly looking at recipes for disaster all the way around.
It is best, if you can, to avoid surgery, certainly of any elective kind.
Your MD will discuss ALL OF THIS and more with you if you ask him/her.
Best of luck.

What type of surgery are we talking about? For anyone your wifes age the anesthesia will effect them. At 65 my Dad was operated on for a damaged valve. He told his doctor he had lost part of his memory. Dr told him the longer your under the more memory you lose as you get older.

For your wife anesthesia may make her dementia worse. It does werar off but seems to take longer when we r older. Being in the hospital may make her worse. Its called Hospital Delirium. People get it in Rehab too.

So depending on the surgery, I would think hard about putting her through it. Being in strange places with strange people may make her anxious and more confused. My Mom wanted no one to touch her especially male nurses. And is Rehab going to be needed. Hard to work with someone suffering from Dementia who can't learn.

I will tell you our story...My mom was acting strange before she had her knee replacement, but we did not have anyone in our family with dementia, so it was never on our radar. We just thought she was being contrary...plus at the time she was not old...still in her sixties. After the knee replacement, all of those strange actions quadrupled and were amplified. Now she was getting lost while driving and seemed overwhelmed with every little thing. We then had her tested and found out she was in moderate stage dementia. My mom is now 83 and in a locked down, Medicaid accepting memory care. I know she would not want to live this way, so if she had some health scare and surgery was the only fix, I would not put her through that. I would not take extra steps to extend her existence with this horrible disease. She has suffered enough...we all have. I do not think the anesthesia from her knee surgery caused her dementia, but I do think it worsened her symptoms.

I don't know the details of your situation...age of family member, stage of dementia, severity of surgery, etc. I feel like all of those things are important when making the decision. Bottom line is that dementia and anesthesia are not friends...

My Mom was Not suppose to be given anesthesia because of her heart . No One called her cardiologist when I asked them to and they went ahead and gave her anesthesia and Placed a feeding tube Inside her . The following Day / Evening she Had a Major heart attack and was brain dead . Then we had to watch her On the Machines and decide to turn off the machines . They Can Not give me anesthesia and I have been kept awake during a few operations . I wouldn't recommend surgery at this point Unless it is really Necessary . Dementia patients have had adverse effects after anesthesia .

Unless it is a palliative surgery to make LO comfortable why prolong the life of someone with dementia?

I can 100% agree with other comments made about undergoing surgery. My mom had hip surgery when she was 75 and another at 78 and lost her mind afterwards. I am 64 and am now terrified of getting surgery that could possibly help my severe back pain. After going through this nightmare of taking care of her I would rather die than be like she is. I also have no one to help with my mom and I have no one to help me either.

I have been dealing with this disease with my mom now for 7 long years. Looking back I wonder if she was already in stages of it prior to the surgery, but was hiding it. She always had notes everywhere. After the last hip surgery it was obvious she had issues. She is actually in better shape physically than I am, but her narcissist personality is still there. She is like dementia on crack and it has affected my own health in so many ways that I wish I was dead. She is delusional, makes up crazy stories, accuses everyone of abusing her, she is paranoid, mean, and will not shut up or sit down. So no way would I ever recommend anyone to prolong this agony.

My husband (70), who had at the time mild (now moderate) cognitive impairment and frontotemporal dementia, was encouraged to get heart surgery to replace a valve and do some other work at the same time three years ago. He would have had to be put asleep first for the tests and then again for the surgery. He was (and still is) capable of making his own decisions and, after reading articles to him about what happens to folks with dementia who are put under anesthesia, he decided not to get the heart surgery. I told him if he got the surgery, he'd probably eventually be living in memory care because of his repaired heart. His thoughts on the anesthesia were, "I've already lost so many memories, I don't want to risk losing more, especially so quickly." I'm glad he chose to not have the surgery because I honestly don't know who he would have been afterward.

Not sure that my MIL has ever bounced back from her emergency open heart surgery 2 years ago. She was 78, and was recovering from mini strokes. A blood clot in her heart was threatening to take her out. She was of a clear mind and opted to have it to save her life. However, she has declined since. So, I have to agree with the others, it is super hard on elders to go under anesthesia and to fully recover from invasive procedures such as surgeries.

My wife is 86 and has short term memory problems. She has had hip surgery, two operations for blocked veins in her leg, a bleeding ulcer, a colonoscopy, and several endoscopes, all requiring anesthesia before each one. As far as I can tell, she has had no after effects. So, it's not a certain thing.

My husband, now 87 years old, had hip replacement surgery in December 2016, done under general anesthesia. In recovery at the surgery center it was obvious that something was seriously wrong--he was delusional, hallucinating and exhibited psychotic behavior. He was also extremely aggressive and combative. He was not like this pre-surgery, although he had been showing signs for about a year of mild cognitive issues. These conditions did not abate during his brief stay there, yet he was discharged home to my care. Anticipating challenges beyond my capabilities and our two-level house, I'd hired a caregiver to meet us at our house and provide support for a period of time. That lasted exactly two hours. After my husband attempted to push both the caregiver and me down the stairs I had no choice but to call 911. They arrived en mass and determined he needed hospitalization, so he was transported to our local, general hospital. He ended up being there for nearly a month, undergoing what could only be seen as experimentation with all manner of scary drugs--anti-convulsives, anti-psychotics, anti-depressives, anti-anti, etc. Nothing worked to calm him down, and I was required to provide 24-7, one on one companion care during his entire stay. I covered 12 hours of the clock, but talk about expensive! And the abuse he inflicted on these people kept any of them from returning for a second shift; I was in hiring mode 100% of the time. I pleaded with hospital staff to have him transferred to UCLA for psychiatric care with professionals familiar with this kind of situation, but was ignored. Finally, out of sheer desperation, I demanded that he be discharged to me, and thus began a years-long semi-recovery. I immediately engaged the services of a psychiatrist and neurologist. And they guided me on weaning him off the narcotics. After about two years, we reached a better place, but it was far away from where we'd been pre-surgery. After a few years of manageable chaos, husband's condition and behaviors began to erode and we were back to the post-surgery state of affairs. So, in mid-December 2022 husband moved to a memory care home in our city--probably the finest available. That lasted only 30 days, and on the second day I was informed that he was incontinent (this was a first) and needed boatloads of adult diapers. A few days later he needed a wheelchair (he was totally ambulatory when he arrived) During the 30 days I received 10 middle of the night calls about him falling or acting out aggressively including hitting and kicking staff and biting another resident. This resulted in 4 EMT visits to the memory care home, 2 trips to the ER and one hospital admission. I won't even spend time telling about the bedlam he caused in the ER and patient wing; again I had to provide 24-7, one on one companion. When he did return to the memory care home, the condition for staying was that he would have to have 24-7, one on one companion. This would cost me an additional $20,000/month on top of the $12,000/month room and board ($32,000/month total), with a minimum 15% annual increase. Too rich for my blood, so I ended our contract and brought him home. His continence never returned nor did his previous mobility. Mid-2023 I finally hired a weekday, daytime in-home caregiver, which has made a huge difference, but still I am left with two ruined lives and huge expenses not covered by any insurance.

My hindsight: If we had been advised that major surgery with general anesthesia for someone with underlying (even undiagnosed) dementia is highly risky, I think we'd have elected to skip hip surgery and use painkillers instead. The price we've paid (physical, psychological, emotional, financial) is incalculable. As we start year 8 of this living nightmare, I regret our decision every day and am bitter and angry that the legal and medical professions won't recognize that prolonging the life of someone with this terminal illness is inhumane.

My husband was in a similar situation during the pandemic. At this point, he had had vascular dementia for five years. Although his surgeon felt surgery was indicated and high risk, he felt that my husband would be very confused and the experience traumatic. Since hospital visitors were not allowed during the pandemic, my sons and I decided not to put my husband through the procedure. My husband passed away recently and the procedure was never performed. My sons and I feel we made the right decision.

Once my mom hit a certain age, her doctor said that no surgeries should be done. Mom and I both agreed with this decision.

My 96 year old godmother broke her hip in September 2022 and had surgery right away. Although it was a month's recovery in the hospital, her cognitive function wasn't altered. The pain of the broken hip was too much to bear so she's very glad they repaired it.

I agree with the comments below. Why try to "fix" things with a person who has dementia, unless it's to make them more comfortable? Surgery has risk of making things worse, especially when anesthesia is involved, and the experience of being in a hospital will not be pleasant.

Would the surgery add quality of life?

Avahusband: It is difficult enough for an elder WITHOUT dementia to undergo the requirements of surgery, i.e. pre op, anesthesia and recovery. Perhaps the surgery for your wife will have to be discussed with her physician.

My Mom had 2 screws put into her hip when she had MCI. Surgery went well, She knew she had surgery and she "worked" like crazy to get back to "independence".

The next surgery was 4 years later and it was for oral surgery. By this time, she definitely had lapses in memory, including accusing people of stealing from her, saying that we never told her about so-and-so, and definitely incontinent. Surgery went well. However, the hospital stay did not. While she was in pain, the hospital stay was "normal". However, as she recovered, she didn't understand that she was in the hospital, she didn't know the difference between the types of people who were coming to her aid. She was a fall risk and she kept on wanting to get out of bed to go to the bathroom. When it got to the night, she wanted the routine that she was used to, sitting outside her door waiting for her bath. Of course, she didn't get it, and she really couldn't sit up yet. They were worried that she would get out of bed and fall down. She started getting combative because she wasn't getting her way, and they ended up tying her in soft restraints to the bed. The problem with that is that supposedly, the managed care facility does not have to take her back if she has been restrained or combative in the last 24 hours. Luckily, the managed care facility knew my Mom well enough that they took her, even though she had been in restraints overnight.

The 3rd and last time she was in the hospital, it was for sepsis. Again, everything was "normal" while she was sick. However, once she started improving, she kept on trying to get of bed....for 6 straight hours. She didn't have the strength and this hospital allowed me to stay overnight and monitor her.

We needed to get an MRI about a month after this last stay. By then she was headed toward the last stages of dementia. We never could get the MRI because she would not lay on the table needed for the MRI. She couldn't remember she was supposed to lay there and not move. She accused the orderly of stealing from her, and she wanted to use her wheelchair, not the wheelchair that was in the MRI room.

Other than that, her stats always improved while she was in surgery.

For my Mom, the surgery was not the issue. It was the hospital stay during recovery that was the hardest.

I too have a long nursing career and a loved one who due to a car accident sustained a traumatic brain injury that has now lead to end stage Alzheimer’s according to his neurologist. He has moderate brain loss and cognitive test 6 mo ago were 7/30. We tried to make memories this summer and in process got covid which caused an increase of memory decline that had him roaming in street at night , to sleeping a lot more, to forgetting how to swim( we have a pool), to not remembering how to dress or even eat. He had a skin cancer removed and what a mess. From tearing dressing off to digging wound open I vowed no more elective stuff, and I use to work in the hospital and in OR and know that yes anesthesia is very hard on older patients and esp those with dementia. He has an aortic valve issue and we had a frank discussion with cardiologist that said he’s not a candidate should it become necessary. At that time we also discussed that if an emergency occurred that was life or death decision that I’d probably only have 5min to decide what to do or all stops would be pulled out and they would do all they could. At that time we decided a DNR would be the way to go as the living will states their wishes. Thankful for the long term care plan we had taken years ago because it became necessary to go into memory care in the last 4 mo. Yes it’s an adjustment for all but the caregivers he has there are wonderful and he is well taken care of. We went to him for TGH and Christmas and if there is an outing that would be ok for him he has gone but they take him because if I took him out it would be hard for me to get him back in . He remembers one of kids not the other and knows me from a name badge but shown pics he usually doesn’t know who’s who. He does basic finger foods cause he can’t remember how to feed himself and ADL’s are all assisted. It has been only 5 years and they thought that was life expectancy.. he is under 70… we take it a day at a time but realize it’s what’s best for him and am getting counseling for me because we all feel like if we arent there a lot that we are neglecting or forgetting them. I am learning that this was not the life he chose and he wouldn’t want me to stop living either so I live for us both. Caregiver support groups are crucial and we all feel helpless. I’m learning there is no universal right or wrong and do not feel like you need to go daily… that truly isn’t for them but for us. He thought I was there all the time but wasn’t for first few weeks as he transitioned and they evaluated his needs and condition. Now I go twice a week and he knows no difference . We make the most of our time together but also aware as soon as I’m out of site it’s as though I had not been there. That said we all want to be there and make sure they are ok but they will never be fully “ok” . If he had a fractured hip that he would benefit from it being fixed then maybe… advances in medicine have made some procedures easier than days of old and spinal anesthesia seems to be tolerated better than general from what I’ve seen but that said that’s probably the only one I might consider… the DNR is a definite choice we made as a result of parents in a similar situation… it’s the hardest thing I’ve ever had to do and fully know now why this is called the longest death.

My 87-year old husband with moderate dementia (vascular and probably Alzheimer's) moved to memory care last March. In August a metastatic cancer was discovered in his armpit. It was something that could not be left untreated. I had extensive conversations with the surgeon and the anesthesiologist about the possible after-effects, my biggest concern by far. Fortunately, he tolerated both the anesthesia and the surgery well with no noticeable further decline. I feel lucky.

The problems are many.
1. ANY anesthesia can have lasting effects on a person. The older you get the more difficult to get past the effects of anesthesia. With dementia it can be days, weeks and sometimes longer.
2. If this is done in the hospital there is the confusion of not being "home" where ever they call home. The lights, sounds, strange people even more confusing.
3. Not being able to do their "normal" routine is upsetting and confusing.
4. With all the confusion may come anxiety and maybe aggression and that will result in heavier duty antianxiety medications this creates a fall risk as well as other problems associated with drugs that kinda sorta "knock you out".
5. Will a person with dementia be able top fully participate in any rehab that is necessary? If not will this greatly effect the quality of life that they have remaining.
6. Is the surgery absolutely necessary? What is the current quality of life? Will the surgery greatly improve the quality of life remaining?
And if any treatment is needed after how will this effect the quality. For example if the person with dementia has been diagnosed with breast cancer. A mastectomy is done. What about follow up will the person understand chemo? radiation? and will they go through these follow up treatments. Will they understand wound care? Or will they pick at stitches, In the hospital will they pulling tubes out (IV's , catheters if needed?)

After all that...
I would opt NOT to have any surgery done.

My mom had rotor repair surgery at almost 90 due to shoulder fracture and muscle tears from a fall while cleaning her house (mind you she had a help that came in, but according to her they never did things just right so she’d proceed to adjust). Surgery well, left hospital after maybe 3 days, and then did out pt rehab at a freestanding PT. She could very definitely follow directions, could do the counting needed and also did her at home exercises and was super motivated. Her goal was to be able to set her hair and be able to do the clasps on earrings & necklaces, lol, as these require moving shoulders for that range of movement. Let’s hear it for vanity! Then couple of years later she took a pretty bad slip n fall moving planters ahead of a freeze; big bad ankle strain & dealt with via PT. Again she was great at PT…. could follow all the various sequences for the exercises, do the counts, etc.

Flash forward & she’s now in a NH and assessed to have Lewy Body Dementia, shes a most pleasant resident but not always in this solar system for knowing current events or recognizing family. Unable to dress herself or understand which arm is L if asked to lift it. Mom falls while pulling her wheelchair that’s behind her. Breaks a hip. In speaking with her doctors - both the medical director at the NH and her old gerontologist (same practice) - both felt that although surgery would go well as mom had no major health issues other than being ancient and anesthesia would have its risk but the bigger issue would be that her dementia was at the point that having her participate in the standard post surgery rehab would be a failure. That trying to get her up & off to PT to learn to walk, shift weight, do strength training, etc. would be futile. She would be completely noncompliant for rehab. That even with a successful surgery and all its risks, which are not insignificant for those on backside of their 90’s, she would still become bedfast. So the decision was no surgery, lots of pain meds, lots of comfort care till the hip healed. She remained at the NH, became bedfast and went onto hospice. Surprisingly she was in hospice for 18 months. Hospice was beyond amazing. Cannot say enough positive things about it.

My point in this is think beyond the surgery and if your family member can do what is needed for the standard post surgery procedure.

I think it all depends on the individual. Age isn't always the disqualifier. I say that because mother had spinal fusion surgery at the age of 90 because she was in really good health and given that longevity is in our family (grandmother - 99.5 and great grandmother 103), and the surgeon said that relieving her of pain would help her quality of life. She went into that surgery and the rehab with a positive, although anxiety filled, attitude. She did a terrific recovery and was pain free.

However, when she fell at age 95 and broke her femur where it met up with her long ago hip replacement, THAT didn't go well. She was frightened, angry, in pain, scared because she knew she could never ever go back to her condo again. Surgery did fix things, but one of the side effects was the post-surgical delusional dementia intensification. All of a sudden, the woman who was experiencing very mild cognitive issues, post surgery, it like went from on a scale of 1-100, from 20 to 110! She didn't know where she was anymore, what year it was, was reliving her past traumatic events from ww2, confused, she was convinced that I, her only child, was an imposter, wouldn't take the meds because she thought 'they' were poisoning her, etc. Sigh.

This went on for about 3 weeks post surgery...and finally started to slowly resolve - although never completely. But during that time, her combative and unhelpful attitude (though not intentionally), created an environment where, during Covid lock downs, didn't have nurses wanting to engage. Thus, mother developed an septic infection...which, after yet another surgery, it all went downhill after that and within a matter of a month.

So, I think it does have to do with the individual, their health, their expectations and outlook.

As with any surgery, there are always risks involved. If you have concerns about your LO with dementia having surgery, you should discuss these concerns with your LO’s surgeon. The doctor will answer all your questions and will help you make the right decision about your LO.

The ER doc told me, every time your LO goes to the hospital, a little bit of them will stay behind.
I agree. It’s hard, and this is why I have a DNR in place for me. When I get to End Of Life, I will have the POLST signed. Don’t crack my ribs; I don’t want to resuscitated to be on a breathing machine. I would not want to put my family in that situation to decide how much longer will I be on this machine….etc.

Often the anesthesiologist (MD who administrates anesthetics) introduces him/her self only moments before surgery.
If that's the case, try to "capture" him directly and advise him of any post-surgical mental effects the patient has suffered in the past.
Some anesthetic agents have a history of producing rather extreme psychological after-affects in the elderly. The patient's physician may note this in his records, but it is the anesthesiologist who administers the anesthetic and chooses which one to use.

It truly depends on the person and the type of surgery. Usually the concerns are about the person taking off bandages or removing sutures/staples. That is easily managed by using "mittens" until the wound is healed enough that this is not a problem. If the person tends to become agitated easily and acts out aggressively, then wrist restraints might be needed for a time until anesthesia wears off and or an anti-anxiety medication can take effect to blunt the anxiety and agitation.