Our mom has Alzheimer’s Dementia and also has arthritis. She’s considering a knee replacement. My sister says surgery will make her more confused, but her doctor says she should be fine. Is that true? What's best for her?
Every patient with dementia faces the risk of becoming permanently worse after a surgery or other procedure, or even after an admission to hospital. While some aren’t, most are affected!
Modern medicine has made us believe we can fix everything, but the reality is—we can't fix everything! And, just because something can be treated, doesn't mean we should!
In attempting to fix one problem, we may cause an unintended consequence in another one (such as more suffering). Our interfering with ‘nature’, may make life worse.
All dementias are incurable and will progress.
In general, we make a patient’s dementia worse when we treat their other problems too aggressively.
Here is a typical example, which we see frequently in rehab. A grandmother with mild Alzheimer's was told her memory wouldn’t be affected by surgery for her colon cancer. Unfortunately, following her operation, she no longer remembered some of her family, couldn’t garden, or even stay alone. The family were upset they weren't warned of that possible outcome; they said if they had known, they wouldn’t have risked the surgery, even though it was cancer.
Why don’t dementia patients tolerate surgery? Because as they lose their short-term memory, they lose their capacity to deal with any change, especially that caused by drugs and treatments, which have been shown in studies to actually accelerate the decline in dementia.
So what should a family do when faced with their loved one complaining of joint pain, heart irregularities, or other significant problems? Everyone—families and doctors—want to make them better; and, I often hear, “doctor, you must be able to do something”!
Although we can’t ‘fix’ the dementia, there are things we can do for comfort and I’ll offer some options and guidelines next time.