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Mama is 89 years old with advanced dementia/alzheimers. Just before Christmas, her ankle broke when she was simply getting up from her lift chair to go to the potty. I was right beside her so was able to catch her and break her fall. She did not hit her head and had a very soft landing...on me. The paramedics were called but did not think she had broken anything and so simply helped get her back in her chair. I noticed some bruising around her ankle soon after and so had her transported to the hospital. (Mama is totally confined to her lift chair except for going to the potty, with which I am always there to assist her). Following her surgery, she has become non responsive. Mama seemingly went from being happy, funny and talkative, enjoying our time together..to almost non responsive, went from eating full meals to only ensure, pedialyte and things like apple sauce, yogurt, mashed bananas. Soon after the release from the hospital, she seemed to suddenly just start chaning this way and I became concerned and had her transported back and it was also discovered she has blood clots in that leg, for which she is being treated. While in the ER for over 14 hours, both she and I caught a horrific virus and Mama has been very sick for the past two weeks. She is now on Hospice care, and they are excellent, but she is no longer vibrant and seems sad most of the time. She will have moments of clarity but mostly just sleeps all the time and just does not want to eat...other than the items I mentioned . Has anyone else experienced a sudden and rapid advance like this after a surgery? They did all the tests to check for possible strokes, etc. and no more than what would be considered fairly normal for someone her age we were told...Her vitals are always excellent. Is it the antibiotics making her this way??? The anesthesia?? I am devastated. Caregiving is so hard, and I get very tired, but I am cherishing our moments together...Now, all of a sudden, it seems she has left me, but has not left me. Has anyone else gone through this....Is there something I could do??? I bathe her face with warm cloths, I sing to her, talk to her, put lotion on her, touch her....please someone tell me there is something I can do......

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There was absolutely nothing else you could or should have done but go ahead with the surgery. How could anyone ignore a broken ankle and the pain your mother would have suffered without surgery. You had no choice. Not knowing the possible risks associated with the surgery at least spared you the preoperation agonizing over should we or shouldn't we, if you know what I mean. I don' t know the extent of your mother's condition,and don't want to raise false hopes, but it is relatively soon after the operation to give up hope for some improvement. Sometimes it takes months for the elderly to recover from the mental effects of anesthesia. Hang on to that possibility. God bless you and your mother.
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It is wonderful that you have hospice in to help her control the pain. Often, old folks break a bone and that begins a very rapid decline to death. You said she is approaching advanced dementia - would you prefer she just die while you remember her well, or when she is a hopeless body, unable to do anything, and no longer the mother you knew?

Not eating is part of the dying process. When they stop eating, they don't feel hunger anymore, but if they are dying and they are continuously fed while their organs shut down, it makes them more uncomfortable. Hospice has been through this before and you can ask them for advice. The most important thing to know is that this may be the end.

I like to recommend Dying Well by Ira Byock MD This book has helped me tremendously. Talk with her, sing to her, bring in family to say hello. Do NOT blame yourself as this is not your fault.
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My mother is 79 years old and has mid/late stage dementia. She is in desperate need of a knee replacement due to her severe arthritis but her doctor said that it was an unnecessary and recommended that we try to manage the pain. He said that any unnecessary surgery was a risk to her dementia. That putting someone under anesthesia can cause their dementia to advance much more rapidly.
I am so sorry that your mother is worse after her surgery but it sounds like it was a necessary surgery for her since she had a broken ankle and had to have the blood clots removed.
Indeed, cherish those moments that you have together. My mother has not advanced to that stage just yet so I can't tell you what you can do.
My heart goes out to you. Take care of yourself and help your mother as you have been. I'm sure that during those moments of clarity she feels your love.
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Thank you for your response. I am so afraid that letting them do the surgery has advanced her condition but my brother and I didn't know what else to do. I did not know that the anesthesia would do this, we were not told beforehand, but had we been told, I don't know what we would have done. I can't imagine her having broken bones "floating" in her ankle and that seemingly could have caused other issues...I don't know...I guess we just do the best we can, but it sounds like the surgery has most likely advanced her condition. I am in total shock that she has gone from being able to enjoy her days and laugh and talk to me to suddenly being totally bedfast and mostly non responsive. I do cherish the moments when she does "come about". Thank you again for your response. I appreciate so very much the advice and the input. :)
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Hope22, so very sorry. I think that had I been told beforehand about the risks that I too would have gone ahead with the surgery. Having broken bones in the body would be extremely painful for her and cause unnecessary suffering and possibly other serious complications. You did the right thing. Don't beat yourself up over it.
It's the disease, not you.
My mother has episodes about once a month where stress or something triggers delusions and hallucinations. After each one of these she declines a bit more.
None of us know what this disease will bring. All we can do is be the best caregivers that we can be and do the best for your loved ones. It's a different experience for each and every one of us.
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What you are seeing is called Post Anesthesia Delirium in Elderly - google this and you can learn a lot about it. I went through this with my father last summer. He went from normal to "wild man" in the hospital. Luckily, he got better although he is still not back to his normal self 100%. Still, studies have shown it can take up to a year for patients to return to as normal cognition as possible. With someone with dementia already, the prognosis is not quite as good, but your mother may still get at least somewhat better - it can take up to a year, it's hard to know for sure as there are many variables. The thing to understand is that with a younger person, if we are anesthetized, we metabolize and expel the anesthesia medication quickly - within 6 weeks at most, but with an older person, the metabolizing of the anesthesia is much, much slower and can takes months or even a year. One thing that is proven to help is pomegranate juice or pomegranate supplements taken daily. There have been many studies which have proven that pomegranate helps. In addition, your mother should be encouraged to drink lots and lots of water. These two things will help wash the anesthesia out of her body.
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After my mom had ankle surgery, she returned to the rehab center where she had gone to before. May I also add that this rehab center was rated extremely high. She was "out of it" for several days. The nurse explained that it's possible it was from the anesthesia. Finally, a couple of days later, I found her in her room at rehab sitting up in a wheel chair. She was totally non-responsive. The nurse checked her blood sugar which was normal, but her blood pressure was 80/50. Rescue was called and she was taken to the hospital. It turns out she had a UTI, her potassium level was way too high and she was dehydrated which caused a toxic level of her medications and reduced kidney function. The wrap from her ankle had not even been removed since her surgery 10 days before. Last but definitely not least, we were informed by her nurse at the hospital, that she had 2 stage 3 pressure sores on her backside which we had never been informed of by the rehab center staff. Before her surgery she had some memory issues and would repeat things she had said before and ask the same question over and over, but now, she asks about relatives who died many years ago. We are amazed that she survived all this, but are thankful. We are taking things one day at a time to see what her recovery will look like.
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It is important, if an elderly person has been catheterized, even for a short period - such as during surgery, that they be carefully monitored for UTI's which can only add to the problem of post anesthesia delirium. My dad had to leave the hospital with a catheter after his cancer surgery and we had several problems with the catheter. Then he had to have another surgery to reduce his prostate to get rid of the catheter - which meant anesthetizing him again. Fortunately, whatever they used for the prostate surgery did not impact him as badly as what was used for the cancer surgery and we only had one day of him being irrational after that surgery yet his memory remained good enough that he was able to call me on the phone multiple times demanding to go home from the hospital. LOL! Still, he was anesthetized 3 times in 2 months - that's hard on anyone, much less someone in his late 80's. All I can say is push the water and pomegranate juice and hope that time will resolve these issues. Remember that it is important to keep our LO's hydrated. Hydration leads to hunger. Hunger leads to thirst. If they are not hydrated, then they won't be hungry and won't eat and then they don't drink and get dehydrated. It becomes a vicious cycle and our elderly loved ones can quickly go into a downward spiral if we don't act to arrest it. You can easily tell if your LO is dehydrated - gently pinch the skin on the top of her forearm. If it stands up like a tent, then she is dehydrated and needs to be pushed to drink fluids. Pedialyte is a good choice since it is not full of sodium like Gatoraide. If the person will not drink fluids, then it is an emergency and I would have them transported to the ER to get IV fluids. I've seen this turn someone around from out of their head and non-functional to nearly back to normal in a matter of a few hours. After they are rehydrated, make sure they eat and also keep track of how much liquid is being consumed and how much food is being eaten to make sure they continue to do better. Unfortunately most nursing facilities don't track liquid and food consumption. This is incredibly dangerous for elderly people because they often will forget to drink and then lose their appetite so they don't eat and on and on it goes until they are dehydrated. Of course, meds build up in the body, especially in the case of dehydration and damage can occur to major organs.

It's very frustrating to me that more is not done to manage the care of elderly people. It is not like this is an unknown phenomenon. As a result, I have always hired 24x7 caregivers to be in the hospital with my parents and monitor them because I know the staff won't. I have my parents in their own home with 24x7 caregivers whose job is to make sure they eat and drink and take their meds and to cook, do laundry and entertain them.
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Thank you all for your answers and input. I keep reminding myself that this is something that is indeed different for each person and each caregiver and it is impossible to predict what is coming next. I do pray that she is going to have many more happy times with us and it is encouraging to know there is hope for her to come back from the anesthesia...I guess it was just such a sudden change and therefore, a huge shock to go from her sitting there and laughing and talking to suddenly just seeming to sleep all the time....I think I had finally settled in and gotten used to the way things were and had finally received some long awaited financial assistance via the VA Aid and Attendance benefit and now this....it seems so horribly unfair to her and to me and to US as a unit...we have always been close. I do believe God will know when in His time she will go home, but I do pray, perhaps on a selfish note, that it is not time for her to go. I cannot even begin to imagine life without her in it...thank you again for your responses and your caring...this site is awesome as a means of support. makes me feel less alone...thank you all and God bless
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Thank you Moxie1. I will Google that and read up...She had a really bad day on Monday and it was very scary. She had a better evening and then yesterday was great...today is pretty much back to the new normal...but I still have hope...thank you for your response. more and more I am finding out so much more than I ever realized about the dangers of anesthesia...
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