Sudden Onset Dementia After Surgery Is More Common In The Elderly Than You Might Think
Note: the suggestions below are just that: suggestions. I realize that they won’t work for everyone – there is nothing that will work for everyone.
I am not a clinician (although I have a medical background) nor a doctor .But, the suggestions are worth trying if you’re dealing with sudden onset dementia post-surgery. Please leave me comments below as you’d like. Onto our story….
The father-in-law (FIL) who went into surgery last Sunday was not the same one who came out! Pre-surgery, my FIL’s mind was sharp as a tack. His wit was amazing, his eyes twinkled, he was, basically, just a normal 70-year-old man, albeit, not in the best of physical health. Mentally though? He could challenge a 20 year old.
Post-surgery? All bets were off.
My FIL is now dealing with sudden onset dementia meaning, well, he is seeing things, talking to no one, mumbling, startling himself awake, etc. These are all symptoms of dementia which he’d never shown before.
In this article, I hope to give you some tips about how to deal with this very confusing, often sad syndrome.
Update: 5 days later, he is back 100%! The anaesthesia evidently cleared. Lesson learned: there’s hope!
Tip #1: Step Into Their World Instead Of Expecting Them To Come Back To Yours
This is probably the hardest thing to grasp for most people. Luckily for me, I still have an active imagination….
When Sunny, my FIL, was in the throes of dementia, he mentally wasn’t with us at all. He thrashed around in bed, he muttered stray words, his eyes were half closed. He even became combative.
At one point, he sat up in his hospital bed, looked at me and told me it was raining on his head!
After a quick glance at the ceiling confirmed my though that this was his mind in the midst of dementia (ie, no ‘rain’), I decided to practice what I preach. I decided to head into his world.
So, what did I do to calm him?
I held his hand and touched his shoulder to get what attention from him I could. And, then? I told him that I’d get an umbrella.
As he watched, I made a big production of pretended to open an umbrella. I even asked him what color it was. He sort of looked at me like I was the crazy one and said ‘flowers.’ That’s how I knew I had him.
I took my ‘umbrella’ to the front of the bed, leaned over and held my it over his head. He looked up at it, sighed, and immediately fell asleep.
Game point: Me.
In stepping into his world, instead of arguing with him (clearly, there was no ‘rain’), I effectively gave him what his mind needed. I fixed a situation he imagined.
And, by stepping into his world. I got a wonderful memory and a great laugh. Success.
Note, later in the day, I ‘took’ him to a carnival! I asked him what ride he wanted to go on first and he pointed to nothing and said ‘Ferris Wheel.’ We stepped on and went to the top where the wheel stopped. We looked around. I asked him what he saw and he noted many things at a carnival. It was truly fascinating to me.
Tip #2: Check Medications Post-Surgery
Even a previously healthy-mind elderly loved one might fall into a demented state post surgery. Sometimes, this is caused by anesthesia and other medications.
The elderly are particularly susceptible to anesthesia but there’s nothing you can do about that. If surgery is needed, obviously, anesthesia will be on board.
You can though review and adapt post-surgery medications for the elderly.
In Sunny’s case, the wrong post-surgery cocktail sent him into a tailspin. He was given both morphine and oxycodone as per hospital protocol post surgery. BUT, the hospital staff hadn’t evaluated his pain level, hadn’t observed the dementia, and continued to dose him until I complained.
In response, we decided to try different pain solutions. We immediately discontinued both the morphine and the oxycodone. Instead, we substituted a muscle relaxant (Flexeril) and added Dilaudid (a different pain med).
He improved enough that we were able to call his name and he would mentally come back to us – sometimes as his former self! Those times were particularly welcomed.
Now, what we hadn’t thought about was morphine withdrawal. He was on a 12 hour dose of morphine at home so his body was used to that drug. While taking it away completely, he showed signs of withdrawal which was, in some ways, more disconcerting than the mental issues. Much twitching, scratching, and yelling ensued.
Realizing our mistake, we discontinued the Dilaudid and added back in a reduced dose of morphine. In about 6 hours, he was much improved mentally. And, his pain was managed.
Tip #3: Try Using Suggestions To Guide A Demented Mind
Sunny was overly medicated at the hospital so the very last thing we wanted was to give him more pain meds to manage what he said was a pain level of 7 out of 10 – note: about 10 minutes before, he reported the pain level as a 2….
So, I got a box of tic tacs and hid it in my purse. When he’d awaken and complain of pain, even though he’d been previously settled, I would pop a tic tac in his mouth and give him a sip of water with a command to ‘swallow hard’.
Swallowing hard helps prevent whatever is in the mouth from going into the trachea, the airway, which eventually leads to the lungs. Make sure your elderly loved one is sitting up when giving oral medications.
Getting water into the lungs could easily cause aspiration pneumonia and no one wanted that!
Sometimes, I’d give him a ‘shot’ of pain killer – I’d give him a very slight pinch in his arm with my fingers. Just thinking that he had additional pain relief on board took care of what he perceived as a high pain level. He would immediately settle back down for a much needed doze.
I just looked on Amazon and found these awesome empty capsules that would be great placebo pills. They’re just gelatin!
Tip #4: Make SURE There Is A Bed Alarm On The Hospital Bed
Bed alarms work by ringing an alarm when pressure is taken off the alarm pad – meaning, your patient might be about to make a run for it.
Sunny’s nurses had already added the bed alarm pad so that was great news. With a newly installed hip, his leg couldn’t bear weight. A fall would have been catastrophic.
My own elderly mom (whom I dearly miss….) had sundowners so I bought and added a bed alarm to her bed in our home. Whenever I heard the alarm, I’d yell for her to get back into bed and it would stop. Of course, it started again in about 30 seconds but we can only do what we can do. At least I was alerted that I was on duty again.
Here’s an article about Sundowner’s that might be helpful if you don’t know what it is.
And, here’s some highly-rated bed alarms on Amazon.com.
Smart Caregiver Bed Alarm and Sensor PadWireless (Cordfree) Bed Alarm and Bed Pad/no Alarm in Patient’s RoomSecure 45BSET-5 Bed Exit Alarm Set for Fall Management and Wandering Prevention – High Quality Caregiver Patient Alert with Adjustable Volume and Tone – Batteries Included
Tip #5: Ask Another Person To Step In To Try And Handle The Situation
Having observed my MIL’s frustration with my FIL’s newly onset dementia, I knew that she wasn’t the person he needed right then.
I gently suggested she go get a cup of coffee, and then I took over.
Sometimes, the elderly react better to someone who is not as emotionally close to them. That’s why my FIL, even in his demented state, reacted better to my touch, my suggestions, or my instructions to lie back and close his eyes. He didn’t challenge me nearly as much as he challenged his own blood family members.
And, when the doctor stepped in the room? Well sir, he was right back with us! The doctor rarely saw the dementia episodes which is absolutely normal for this situation….and, absolutely exasperating to those who know the truth.
Tip #6: Do Not Talk About The Patient In Front Of Him
Even though you might think your loved one is not going to comprehend what you say, don’t believe that.
Hearing, for some reason, remains acute even though we, the right-minded (ha!) think our loved one might be out of it, floating around la-la land or some other imaginary place.
But, there is still a part of the patient’s mind that works those ears and, danged, if Sunny didn’t hear everything!
So, when the doctor came in and saw a perfectly sane Sunny, I knew we needed to alert the doctor to the real situation. But, I knew enough not to sway his diagnosis in front of Sunny.
As the doctor was leaving, I followed him out the door and told him the real story. He smiled and said he already recognized that. He was a smart doctor and realized that patients reacted differently when he was around.
Tip #7: Join Some Facebook Boards For Online Support
I would be remiss if I didn’t thank the members of the best Facebook board – Mother and Son’s Journey with Dementia. If you have or are dealing with dementia or Alzheimers, you need to join. I put up a question about dealing with this subject and got many many supportive answers. In fact, that’s how this article came about.
Another excellent board is Gilly B’s Dementia Care – Love Laugher Tears & Lessons With Gilly B. Her husband has Lewy Body dementia. She’s got live podcasts which are very informative and really entertaining. She has a great sense of humor which helps get one though this kind of situation.