When surgery is recommended for a person with Alzheimer’s

Caregiver holding elderly patient’s hand in hospital bed

Surgery is scary for everyone. But when the patient has Alzheimer’s it can be traumatic. Someone with Alzheimer’s may feel frightened and confused by a new environment and by people they don’t know. They may not understand what is happening to them. Their normal routine will inevitably change, as well as their diet. The list goes on and on.

If your loved one’s doctor is recommending surgery, you’ll want to ask a lot of questions because being in a strange environment will likely cause anxiety (although some patients with dementia might enjoy the special attention). And getting general anesthesia can cause dementia to worsen.

A study published on the Fishman Center for Alzheimer’s Research Foundation’s website found that about half of the patients undergoing surgery at the Marques de Valdecilla-IDAL University Hospital in Spain showed declines in cognitive skills after their hospital stays. https://content.iospress.com/articles/journal-of-alzheimers-disease/jad191229 But those who had high levels of beta-amyloid, consistent with an increased risk for Alzheimer’s disease, fared the worst on measures of memory. All the patients were older than 65, and none had dementia before their surgery. https://www.alzinfo.org/articles/prevention/major-surgery-may-accelerate-the-slide-into-alzheimers-disease/

However, Duke University researchers recently found that “in over 100 patients undergoing a wide variety of major surgery types under general anesthesia, we found no correlation between post-operative changes in thinking/memory and in Alzheimer’s disease-related biomarkers in the fluid surrounding the brain and spine . . . This should be a reassuring message to anesthesiologists, surgeons, older surgical patients and their family members,” said lead author of the study Miles Berger, M.D. https://corporate.dukehealth.org/news/no-link-between-cognitive-changes-alzheimers-markers-after-major-surgery

Things to consider

  • Plan a consultation with the doctor to discuss the specifics, and have an honest discussion. Is the surgery absolutely necessary? What might happen if your loved one does not undergo surgery? Will the surgery provide a better quality of life, i.e. reduce pain and increase mobility? Prolong the person’s life? What is the worst-case scenario if they do not undergo surgery? Is there an alternative solution to the problem, i.e. complementary medicines and/or modalities such as acupuncture or biofeedback? Ask if you can record the discussion in order to review it later. Consider getting a second opinion.
  • If your family member plans to go ahead with the surgery, look for a hospital that has adopted the ACS Geriatric Surgery Verification Program. The medical community is starting to recognize that a routine surgery for an adult may be very different for an older patient, especially one who has dementia. The Geriatric Surgery Verification (GSV) Program has 32 surgical standards (two of which are optional) designed to improve surgical care and outcomes for older adults. Optimizing surgical care for older adults is critical, as patients 65 years and older account for more than 40% of all inpatient operations (and increasing).https://www.facs.org/quality-programs/accreditation-and-verification/geriatric-surgery-verification/
  • Before surgery make sure all the legal papers are signed and in order such as a DNR (do not resuscitate), POA (power of attorney), etc., and that you hand over the appropriate signed documents to the medical facility or doctor.
  • If your loved one falls and breaks a hip, or is injured in an accident, you will have to make swift decisions. Keep a copy of the important documents mentioned above in your glove compartment. Be prepared for the patient to experience “delirium” afterward. This is common among people with Alzheimer’s who need general anesthesia. Stay calm. There’s a good chance the patient will recover and revert back to their usual state. However, as mentioned above, 50% of older patients who undergo surgery show cognitive decline afterward.
  • If the surgery is pre-scheduled do everything you can to make the hospital experience as easy as possible. Bring favorite “toys”, music, clothing, foods, etc. Have someone who is comfortable with the patient, and whom the patient is comfortable with, stay overnight, if possible.

Patient delirium

Delirium after surgery is common for older people and those with Alzheimer’s disease. It’s a byproduct of anesthesia and the stress of being in an unfamiliar environment where there’s a steady flow of nurses and care providers coming in and out of the room. Remind the nurses to introduce themselves when they come in to care for your loved one. This will help make the experience less stressful.

Your loved one may not remember that they had surgery. Let them know what it was for and that they’ll get better. Tell them where they are, who will visit or already visited, and how long they will be in the hospital.

Try to distract your loved one if they don’t understand what is going on, and if they try to get out of bed. If they normally watch TV, watch it together. Put on their favorite music, or read to them. Aromatherapy essential oils are wonderful for calming down someone with anxiety and agitation.

Aromatherapy

Aromatherapy can be a resource of comfort to you and your care partner by providing an easy, natural way to reduce stress and anxiety and uplift mood. To make sure you are buying a pure essential oil and not synthetic fragrance oil, look for the botanical name of the plant and the phrase “pure essential oil” on the label. Essential oils can be used in a wide variety of ways, but the most common methods are by inhalation or topical use, such as lotion, body oil, or in a bath. My favorite method which I used for my husband is an electric micro-mist diffuser, and available by mail order or at health food stores. These disperse essential oils into the air in a cool mist or can be gently warmed in a candle-heated aroma lamp that releases the aroma into the air. Another easy way is to add 30-40 drops of essential oils to a 4-ounce water spritz bottle. Favorite oils for reducing stress and anxiety include: lavender, Holy basil, clary sage, geranium, rose, and ylang ylang. Citrus oils uplift the mind and emotions, relieve stress and anxiety, and are useful for appetite support: bergamot, grapefruit, lemon, and orange.

Aromatherapy is also great for caregivers!

Barbra Cohn cared for her husband Morris for 10 years. He passed away from younger-onset Alzheimer’s disease in 2010. Afterward, she was compelled to write “Calmer Waters: The Caregiver’s Journey Through Alzheimer’s & Dementia”–winner of the 2018 Book Excellence Award in self-help– in order to help other caregivers feel healthier and happier, have more energy, sleep better, feel more confident, deal with feelings of guilt and grief, and to ultimately experience inner peace. “Calmer Waters” is available at AmazonBarnes & NobleBoulder Book StoreTattered Cover Book Store,  Indie Bound.org, and many other fine independent bookstores, as well as public libraries.

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