When Medical Care Becomes More Intensive

Preparing for Anesthesia, Medications, and Hospital Stays

In 2016, Dan, my husband of 59 years, was an active 78-year-old full-time website administrator. He loved his job, worked on projects, and was always planning activities for us. While he took no prescription drugs and was relatively healthy, he was also showing signs of memory loss. Overall, though, he was managing.

That is, until he had emergency surgery and was hospitalized for nine days. Whether he needed the surgery remains a question in my mind, but the doctors said he did, and I wasn’t knowledgeable or assertive enough to refute them at the time.

While in the hospital, Dan was disoriented, combative, and confused. When he came home, his body quickly recovered, but not his memory.

When we realized it was not improving, I spoke with the anesthetist, who assured me that while memory issues do occur, patients typically recover quickly. Our doctor tested him and said there was no problem; we took her word for it.

We knew his memory was failing, and there was no cure, so our children and I decided to deal with the issues as they arose and let him live as normal a life as possible for as long as possible.

Within a year, Dan was forced to retire; he could no longer do the job. He got lost on trips to the grocery two miles from home and couldn’t remember the names of people he knew well. For the next few years, his memory worsened, and we coped. I reluctantly took over as the head of our household and became his primary care provider.

When I couldn’t manage his behavior any longer and didn’t feel we were safe, he moved to a locked memory care facility, where he contracted COVID and died.

I’ve written about his story before; it was the most traumatic time of my life. It haunted me, and I had to understand why. Yes, he was experiencing memory loss, but he was functioning normally until that hospital stay.

Afterward, his memory deteriorated dramatically. He would have periods of clarity, but then he’d forget or deny what he said or did, like make a doctor’s appointment and then refuse to go.

So, I began reading about older adults taking multiple medications, having anesthesia, and being hospitalized for a period of time. I was stunned and truthfully furious. Why wasn’t this information included in the discussion when I was making decisions about his surgery, hospital stays, and memory care experience?

Today, I’d be better prepared: ask many questions about side effects and complications, ensure that doctors are aware of relevant health and medication issues, and be well-informed about the illness before making such life-altering decisions.

The bottom line is that age-related changes in metabolism, brain chemistry, and organ function can increase sensitivity to drugs and raise the risk of confusion, delirium, prolonged recovery, or adverse reactions.

Most of us don’t think much about hospitals or what that entails until we need them. But as we age, these experiences may become more likely—and often more complex —physically and emotionally.

So, understanding how they affect older adults and knowing which questions to ask can help patients and caregivers advocate for safer care, smoother recovery, and better outcomes. Here’s what I’ve learned.

Prescription Drugs

According to the National Institute on Drug Abuse, substance use disorder (SUD) is a growing issue in adults aged 65 and older. They’re more likely to take prescription medications and experience chronic pain and health problems associated with aging, which, in turn, can contribute to substance misuse and complicate treatment.

Anesthesia

According to a recent study, many older patients suffer long-term mental decline after major surgery. Research also identified the issue of cognitive decline after surgery as a cause for concern that is not receiving adequate attention.

The aging brain is more vulnerable to anesthesia, especially when deep surgery is involved. Heart or lung disease, Alzheimer’s disease, Parkinson’s disease, or having had a stroke increase the risk.

I wonder why those risks were never mentioned before my husband’s surgery.

Hospital Stays

Studies found that hospitalization can accelerate cognitive decline in older adults. Results indicate that even a short stay might result in a mental delay two times faster than a person’s rate before hospitalization.

When I realized that Dan, who was already experiencing some memory loss, had anesthesia for surgery, took no prescription drugs prior to the stay, where he got pages of meds, and was in the hospital for nine days, the outcome made sense.

We went through hell for four years, beginning with the emergency surgery. I’ve agonized about what I could have done differently. These ideas come to mind:

• Ask questions, such as whether a specific medication was necessary or whether there were less invasive options before surgery.

• Learn about the prescribed medications and their combined effects.

• Check with the anesthetist in advance regarding potential risks and concerns.

• Give doctors a list of prescriptions and over-the-counter drugs being taken at the time, and if memory issues are involved.

• Request a second opinion or contact the family physician first. We went to the emergency room - that was not the best first option.

• Listen to my intuition. I questioned several decisions, but didn’t speak up.

• Be more assertive with him and the medical professionals.

• Get prescriptions to manage his anxiety and aggressiveness.

I couldn’t change the course of the disease, but maybe we could have managed better, and he could have remained home a while longer if we had been better prepared.

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Dr. Janice Walton is a psychologist, a widow, a mother, a grandmother, a great-grandmother, and a writer. She’s been publishing articles on Substack for the past five years and has recently written a book based on those aritcles - one more way to read them.