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.

How dehydration can lead to delirium and other health issues

Different drinks in glass jugs on white background. Ideas for summer cocktailsIt’s hot outside and it’s easy to get dehydrated. Our body is 50-65% water. The brain, which is 70% water, gets dehydrated just like your body. When it is dehydrated, neurotransmission—which is heavily dependent on water—is impaired, resulting in poor memory, concentration and impaired abstract thinking.

Dehydration can also result in delirium. Delirium is a mental disturbance that is exhibited by a new or worsening confusion, changes in one’s consciousness or by hallucinations. It has a sudden onset from hours to days. It can be reversed but it’s easier to prevent delirium than to reverse it.

When my mom was admitted to the hospital for a UTI (urinary tract infection), she developed delirium. A psychiatrist called me to report that my mom was exhibiting full-blown dementia. I had just spoken to Mom a day before and she sounded fine. I refused the offer of an antipsychotic drug for her, knowing well the high risk of putting an older adult on those drugs. (see Why you should throw away that antipsychotic drug prescribed for your loved one). As it turned out, my mom was severely dehydrated. After a couple days on a hydrating intravenous solution she returned to her normal self.

It’s important to learn the signs of dehydration in everyone, but especially in seniors and young children. The physical symptoms are usually clear: dry lips and mouth, no tears when crying, decreased urine output, sunken eyes, headache, lethargy, dark urine and extreme thirst. The mental symptoms are not as obvious, but can result in mental confusion, irritability and delirium.

Many older adults often limit their fluid intake because they may be incontinent or fear accidents. Those who have limited mobility may try to avoid another trip to the toilet. Individuals who have aphasia (inability to speak due to dementia or brain damage from  stroke, etc.) may not be able to express their thirst.

If you are a caregiver, and that includes caring for yourself!) here are some helpful guidelines:

  • Encourage and remind your care partner to drink.
  • Drinking healthy fluids is important as eating healthy foods. Water is the top choice, followed by milk, vegetable and fruit juices. Remember that juices contain a lot of sugar, both natural and added, so don’t overdo them. Soups are nourishing and hydrating but be aware of the sodium content. Avoid carbonated and caffeinated drinks which have a diuretic effect.
  • Serve liquids at a temperature that your care partner likes. Not everyone enjoys ice water.
  • Flavor water with lime or lemon.
  • Remind your care partner not to wait until s/he is thirsty. By then s/he is already dehydrated.
  • Serve juicy fruits such as watermelon, which contain lots of water.
  • Offer healthy popsicles as an addition to drinks and to those who refuse water.

The rule of thumb is to have 48 to 64 ounces of non-sweetened, non-artificially sweetened drinks. Hydration keeps the body in proper pH (how acidic or alkaline your body is) and protects it from getting dehydrated, which is a cause of inflammation and other kinds of imbalances. Dehydration can also contribute to urinary tract infections (UTIs).

The dangers of UTIs

Urinary tract infections are notorious for causing delirium and delusional behavior in the elderly. When younger people get a urinary tract infection, they typically experience painful urination, an urgent need to urinate, lower abdominal pain, back pain on one side, and fever and chills. However, an older adult might not experience those symptoms. As we get older our immune system changes and it responds differently to infection. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal. In older adults with dementia, these behavioral changes may come across as part of that condition or signs of advanced aging. If the underlying UTI goes unrecognized and untreated for too long, it can spread to the bloodstream and become life-threatening. In fact, I have a dear friend who died from a UTI that quickly became septic.

Always: Keep the patient hydrated since urination can flush out unwanted bacteria from the urinary tract.

The next time your mind is muddled, drink a tall glass of water and notice the difference. Drink plenty of water, fresh juices, and herbal teas to stay hydrated, flush out toxins and enjoy mental clarity—in summer and all year round.

 


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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.