Had I Only Known!

A Troublesome Trio for Seniors

My definition of aging well is “to be the best I can every day given life’s circumstances.” However, the past five years handed me a set of circumstances that challenged me in unimaginable ways as my husband of 50 years progressed through the stages of dementia.  

Daniel was a very active 78-year-old man: he had a full-time job as a website administrator, he enjoyed outside hobbies, and we played together. He took no prescription drugs and was very healthy. True he was forgetful, but he was coping effectively.

Then, he had emergency surgery and was in the hospital for nine days. Whether he really needed the surgery, is questionable in my mind, but doctors at the hospital said he did and I wasn’t knowledge enough to refute their decision.  

They would say the surgery saved his life; I would contend that it also ruined his life.

While in the hospital, Daniel was disoriented, combative, and confused. When he came home, his memory didn’t come with him.

As we realized that his memory was worse, I talked to an anesthetist who said that sometimes memory issues occur; but typically patients improve. Our doctor tested him and said there was no problem; so, we continued and his memory continued to decline.

Within a year, he was asked to retire from his job, he got lost while running short errands, and couldn’t remember things he once knew. For the next two years, his memory worsened, but we managed as I took on the role of primary careprovider.

When the pandemic hit, we were forced to stay home. That meant no trips to the senior center, no walks just to browse, and no one visiting. He became even more confused, more argumentative, and more forgetful.

Finally, he had to be confined to a memory care facility where he contacted COVID, was hospitalized again for ten days, and subsequently died.

In an effort to understand, I began reading about older adults taking medications, having anesthesia, and staying in the hospital. I was surprised and really quite angry at what I found. Why wasn’t this information included in the discussion when I was making decisions about his surgery and hospital stays?

 While there is no doubt that prescription drugs, anesthesia, and hospital stays are necessary at times, there is information that should be made available and discussed as life-changing decisions are made.

Prescription Drugs

Almost 90% of older adults regularly take at least one prescription drug, almost 80% regularly take at least 2 prescription drugs, and 36% regularly take at least five different prescription drugs.

When over-the-counter and dietary supplements are included, those rates are higher. Women typically take more drugs than men. Older people who are frail, hospitalized, or in a nursing home take the most drugs. Nursing home residents are prescribed an average of seven to eight different drugs to take on a regular basis.

According to NIDA (the National Institute on Drug Abuse)

Substance use disorder (SUD) is a growing issue in adults aged 65 and older in the United States. Older adults are more likely to take prescription medications and experience chronic health problems associated with aging, including chronic pain. These factors, as well as stressors, such as grief and loss of independence, may contribute to substance misuse and complicate SUD treatment in older adults.

For some, taking medications is essential to maintaining health and can’t be avoided. But evidence suggests - and experts agree - that millions of people are taking more medications than necessary. The more drugs taken at the same time, the greater the risk of adverse interactions and potentially devastating side effects due to the cumulative impact and the mixing of drugs.

Before Daniel went to the hospital, he took no prescription drugs, while he was there, he was given too many to count.  My intuition said it was wrong, but they were the professionals, so I said nothing.

When he was at the memory care facility, he was given a new set of drugs, and when he was hospitalized with COVID - even more. I wonder what the effect of all those medications were on his memory.

Anesthesia

According to a new study, many elderly patients suffer a long-term mental decline after major surgery.

“The issue of [mental] decline after surgery is a very important one that has not received adequate study," says lead researcher Terri G. Monk, MD, an anesthesiologist with Duke University Medical Center.

One concern for older patients is that the aging brain is more vulnerable to anesthesia, the medication given during surgery. There are two anesthesia-related surgery risks, which are more common in older people.

The first risk is postoperative delirium. This is a temporary condition that causes the patient to be confused, disoriented, unaware of surroundings, and having problems with memory and paying attention. It may not start until a few days after surgery, may come and go, and usually disappears after about a week.

The other risk, postoperative cognitive dysfunction, (POCD) is a more serious condition that can lead to long-term memory loss making it difficult to learn, concentrate, and think.

Certain conditions such as heart or lung disease, Alzheimer’s disease, Parkinson’s disease, and having had a stroke increase a person’s risk for POCD.

I wonder why those risks were never mentioned prior to Daniel’s surgery?

Hospital Stays

There can be psychological and physiological effects of long term hospital stays.

Psychological Effects

A 2012 study from Neurology suggested that in elderly patients, cognitive decline is more than double after a hospital stay, affecting patients' thinking and memory skills. The longer the hospitalization, the greater the effect.

A study conducted by researchers from Rush University Medical Center discovered that hospitalization may cause a senior's cognitive ability to deteriorate faster than normal. Results indicated that even a short hospital stay can result in mental delay that is two times faster than a person's rate prior to hospitalization.

Physical Effects

For elderly patients, a hospital stay can bring new health issues and disabilities to the forefront. Because hospital patients are typically bedridden for much of the day, they become weaker and are less able to resume their daily routine after discharge.

Research shows that about a third of patients over 70 and over half of patients over 85 leave the hospital with a greater level of disability than when they arrived. 

Before he contracted COVID, Daniel had adjusted fairly well in the memory care facility: he worked in the kitchen, helped in the garden, got around on his own, and was making friends.

Then he was hospitalized for ten days. He didn’t get out of bed, was spoon fed, and had to rely on a catheter. When he returned to the memory care facility he needed a diaper, a hospital bed, and had to have help when he walked from the bed to the chair.

His psychological and physical health deteriorated enormously. True, COVID played a role, but the following article added to my concern.

For elderly patients, a hospital stay can bring new health issues and disabilities to the forefront. Because hospital patients are typically bedridden for much of the day, they become weaker and less able to resume their daily routine after discharge.

Research shows that about a third of patients over 70 and over half of patients over 85 leave the hospital with a greater level of disability than when they arrived. 

The combination of prescription medications, anesthesia, and hospital stays seem to have been a debilitating trio for someone like Daniel, who wanted to live to be 100.

We went through hell for four years beginning with that emergency surgery. I go over and over in my mind what I could have done differently to have better advocated for him.

In retrospect, I would:

• ask many more questions, such as whether a certain medication was really necessary or whether there were options other than surgery.

• learn about the medications he was being given and the effects of mixing them.

• check with the anesthetist ahead of time regarding possible risks.

• give doctors at the hospital more information about him such as the fact he was taking no prescriptions at the time and that he was having some memory problems.

• request a second opinion or contact our family doctor.

• listen to my intuition – I was questioning several decisions that were made.

• work to get him out of the hospital sooner.

• had a much stronger /louder voice.

The following website offers terrific ideas. Take a few minutes to read it. Had I seen it four years ago, I would have done things differently and we might have been able to age well together for a few more years. But that was not to be.

My hope is that this article will provide suggestions you can use if you are in a similar position.