Talk with doctor before procedure requiring anesthesia; Caregivers Corner

Dear Mary, Your recent article about hospital stays for individuals with dementia was helpful, but you neglected to talk about the effects of anesthesia, particularly on someone who has dementia. My family member's cognitive abilities took a drastic downhill spiral after a recent procedure which required anesthesia.

Dear Reader, For a healthy, young individual, anesthesia side effects can include temporary confusion and memory loss, dizziness, nausea and vomiting. Older patients, particularly those who already have shown signs of dementia, are at a higher risk of developing postoperative delirium or postoperative cognitive dysfunction.

Delirium is a medical condition that results in confusion and other disruptions in thinking and behavior. Individuals living with dementia are highly susceptible to delirium. Unfortunately, it can easily go unrecognized, even by health care professionals, because many of the symptoms of delirium and dementia are the same.

Sudden changes in behavior, such as increased agitation or confusion, may be dismissed as the natural progression of dementia. However, in dementia, changes in memory and intellect are slowly evident over months or years. Delirium is a more abrupt confusion, emerging over days or weeks, and represents a sudden change from the person's previous course of dementia.

POCD can cause confusion and disorientation for several weeks after surgery and can lead to prolonged hospitalizations.

There are several reasons anesthesia causes POCD or delirium in older patients whose brain functions may already be compromised. The drugs themselves directly affect brain chemistry or alter the flow of blood and oxygen to the brain. Additionally, genetic factors, the stress of being hospitalized and undergoing surgery, and the neurological changes that have already occurred leave the brain with less reserve to cope with the side effects.

On-staff anesthesiologists at hospitals often work with patients of any age group. If your loved one is scheduled for a procedure requiring anesthesia, check to see if the hospital has a geriatric anesthesiologist on staff. These doctors specialize in treating older adults and have specific experience caring for patients of this age group both preoperatively and postoperatively.

Talk to the specialist, surgeon and anesthesiologist before any surgery and ask:

*Is the surgery absolutely necessary or can the condition be treated in another manner?

*Is sedation or anesthesia going to be used?

*What alternative anesthesia drugs are available and which work best with dementia patients?

*What will be done after the surgery if any of these problems arise: a sharp drop in memory, postoperative delirium or postoperative cognitive dysfunction?

In order to help prevent complications, the caregiver should inform the anesthesiologist of all current medications (including over-the-counter medications and vitamins), including dosage and frequency.

In addition, family members also need to be honest about how the patient functions on a daily basis. If your loved one isn't functioning well at home, they may struggle more with the effects of the anesthesia, especially with confusion and delirium.

After surgery, report any changes in behavior, concentration, memory or other cognitive functions to medical staff so they can determine whether any action needs to be taken. Sometimes delirium can be a sign of infection or pain which need to be treated.

Although it can be difficult in a hospital setting, try to ensure that the environment for the patient during their recovery is as comfortable and familiar as possible. This can help reduce confusion and anxiety.

Dear Mary, What is the connection between UTIs and dementia? My mother (who has Alzheimer's) seems to get one urinary infection after another.

Dear Reader, A urinary tract infection, or UTI, occurs when bacteria travels from the urethra up into the bladder and kidneys. When a younger person has a urinary tract infection, they will experience distinct physical symptoms such as painful urination, an increased need to urinate, lower abdominal pain, back pain on one side, fever and chills. But because the immune system of an older adult has changed over time, those same symptoms may not be present. Instead of pain symptoms, seniors with a UTI may show increased signs of confusion, agitation or withdrawal.

Urinary tract infections can exacerbate dementia symptoms; delirium cause by a UTI can develop in as little as one or two days in a person living with dementia. Symptoms of delirium can range from agitation and restlessness, to hallucinations or delusions.

To help minimize risks for a urinary tract infection, follow these precautions:

*Monitor fluid intake, encouraging your mother to have six to eight glasses of water a day; this in itself can be an overwhelming amount, so offer small amounts frequently.

*Prompt her to use the bathroom approximately every two to three hours.

*Ensure that good hygiene is maintained, particularly in the genital area.

Be aware of sudden behavior changes. Falls, confusion, anger, depression or an onset of incontinence may warn of a possible UTI. Contact your loved one's physician for guidance.

Questions and comments can be sent to Mary Chaput at the Department of Aging and Disabilities, 7320 Ritchie Highway, Glen Burnie, MD 21061, or by contacting 410-222-4339 or agchap01@aacounty.org.

Credit: Mary Chaput - Questions and comments can be sent to Mary Chaput at the Department of Aging and Disabilities, 7320 Ritchie Highway, Glen Burnie, MD 21061, or by contacting 410-222-4339 or agchap01@aacounty.org.