Alzheimer`s Disease/dementia and surgery
QUESTION: Hello. My father is 75, he was diagnosed a few yrs ago with lewy body dementia. In hindsight he has had it quite awhile. he has been in the nursing home almost 2 years. he is further along in his dementia. he barely makes sense and has difficulty walking, he is weak. last week they found him on the floor, they aren't sure if he fell or what. he ended up having a broken hip. he had surgery 2 days ago, he still has not woken up. he groans and did squeeze the nurses hand. he isn't swallowing and they are concerned about his shallow breathing. they did an xray and do not see pnuemonia yet, they did mention early stage of CHF? he already has COPD, and was "gurgling" as they called it prior to the surgery. They are doing a swallow study tomorrow to determine if he will require a feeding tube. I live 4 hours away, and have two young children, full time job. I know I will go down there, but do not want to go too early (not to sound insensative), but I have a feeling this is the end, but I am not sure what to expect. My mom is opting for no feeding tube and he has a DNR. How long could all of this go on? I know there isn't a definative answer, but just wondering if we are looking at days or weeks. He is on light pain meds as they are trying to get him to wake up, but I don't want him in pain either. Thank you for any light you can shed on this situation.
ANSWER: Hello Jackie:
I'm very sorry to hear of your father's recent decline and current pain. I'm sure it's upsetting for your mother to have to watch this.
Having surgery and anesthesia when one has dementia usually makes the dementia worse. He is at high risk for a pneumonia since he's in bed and not moving around or breathing well. I'm afraid it doesn't look good for a very positive outcome Jackie. I would have a very frank discussion with his doctor before making any major decisions. Ask what are the odds of getting a pneumonia? What are his chances for a recovery that will not include walking because by the time he improves enough for walking, his brain will likely have forgotten how to walk, so probably the best you could hope for would be the surgical site would heal, and he would be in a wheelchair. He then may continually try to get up and walk since he will forget he cannot--so he would be at very high risk of more falls.
It's perfectly understandable that you cannot be at his bedside continuously with all of your responsibilities and there is literally nothing you can do to help him. Please just continue to help support your mother. I think that if he had requested the DNR when he was able to, then he would probably not want the feeding tube either. There is a good chance he would continually try to pull it out and studies aren't encouraging for feeding tubes to extend or improve the life of the elder with dementia by much at all. If his heart is strong and he doesn't get pneumonia, then he could improve and be discharged to the nursing home in a week or so. If he does contract pneumonia, then the family must decide if they want nature to take it's course and not try to clear it up with antibiotics. I would ask the doctor about hospice options since they would be able to make him much more comfortable if he is indeed, near the end of this life. If you opt for antibiotics, then he could linger for weeks, but that's still not a guarantee that he will recover enough to return to the nursing home. I wish I could be more helpful Jackie, but it's really best to ask the doctor since he/she would be able to guess more accurately than I ever could. I wish you and your family much love and support as you all try to do the best for your father near the end of his dementia. Cindy
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QUESTION: Thank you very much for your reply and kind words. I appreciate you taking the time to answer.
He still has not fully awoken, he has yawned a few times, laughed once and squeezed my brothers hand, but as of this morning he was not awake. They are attempting some barium study this afternoon along with another CT scan and chest xray, there was some talk about fluid in is right lung, is that pneumonia?
We have opted for the feeding tube if necessary. My mom thought about it long and hard and said she never starve her dog, why would she her husband that if it's his time to pass he will, that the nutrition really will not be prolonging his life? at that time they would also give him moraphine. He had a fever and they start antibiotics yesterday.
They didn't say anything about his urine, but my mom noticed the urine in the bag was a dark dark orange. She was going to inquire today. She lives about an hour from where he is at and we are under a winter weather advisory today.
I am not really sure what to expect from here with him. Is this something that could drag on for a long time?
Thank you again. I appreciate your feedback.
Hello again Jackie:
If there is fluid in his lung, then that would likely indicate pneumonia. The fever would also point toward an infection. If the urine is very dark, and he's been on sufficient fluids through his IV's, then that could indicate his kidney's are beginning to shut down. It doesn't sound good from my perspective Jackie, but again, depending on how strong his heart is, and if his kidney's don't shut down, he could survive the infection and go on for some time. You might consider calling the doctor's office to set up a conference call with your siblings and your mom with the doctor. My prayers are with you. Cindy