Alzheimer’s Disease and Surgery

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Logo for UNC Chapel Hill, Cecil G. Sheps Center

If your loved one with Alzheimer’s has a serious health issue, surgery can sometimes improve their quality of life.

To decide if they should have the surgery, you’ll need to understand the goals, what problems could come up, and what risks they’ll face. You’ll also want information about what may or may not happen if they don’t have the operation.

In an emergency, you may have to decide quickly. It if isn’t urgent, you may have a long time to make up your mind. You’ll need to talk with several doctors, as well as other family members. They should understand the reason for the surgery. If they can take part in the decision, your loved one should understand as well. If they have any advanced directives, these should give you instructions to follow.

Before Surgery

Be sure you understand your loved one’s diagnosis. Know what results you can expect from the surgery, and what the risks and benefits are. Learn the name of the procedure and the surgeon who will do it. Find out where it will happen, whether it’s in a hospital or outpatient surgery center.

Ask your doctor what tests and other procedures your loved one will need before the operation. These will depend on their health, age, and the type of surgery they’ll have.

Find out what you’ll need to bring to the surgery. Ask what medications they need on the day of surgery, especially if they take blood thinners or insulin. You’ll also want to know if they need to take an antibiotic before the operation. The hospital usually tells people to not eat or drink on the day of surgery, but they often make exceptions for drugs like blood pressure medication.

Before the surgery, your loved one should have an appointment with the surgeon. Don’t be afraid to ask questions about the procedure. Bring a list of questions to make sure you understand the process. Before you go forward, you and your family should feel confident in the decision about whether to have the surgery. Some important questions to ask are:

  • Can you tell me more about the procedure?
  • Where will they do the surgery?
  • What does my loved one need to do before the procedure?
  • At what point will they get the anesthesia? What type will they receive?
  • Who will give the anesthesia?
  • When can I speak with the anesthesiologist?
  • Do the anesthesia and operation cause any specific problems for someone with dementia?
  • How long will the entire surgery take?
  • Will the anesthesia make my loved one sick to their stomach?
  • Will they be in pain when they wake up?
  • When will they be discharged, and where?
  • Will they go directly home or somewhere else for rehab first?
  • How long will it take for them to heal completely after the surgery?

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Once you’ve made the decision to have surgery, you’ll have a pre-operative appointment with the surgeon. This is the time to share any concerns that you or your loved one have about the procedure. Give the surgeon your loved one’s medical history, including any allergies or diet issues they have. Be sure to discuss past surgeries and provide a list of all the medicines your loved one takes, including over-the-counter drugs, vitamins, and supplements. Some can affect the anesthesia and surgery.

Ask about the type of anesthetic and its potential effects. If your loved one has had trouble with it in the past, let the surgeon know.

Finally, it’s important to be realistic about your loved one’s mental state and physical well-being. These will give you an idea about how well they’ll handle surgery and any rehabilitation afterward.

Find out how soon after the procedure your loved one should be able to go home. Be sure to ask what special supplies or equipment you might need to have once they get there. If they’re going home the same day, it'll be especially important to have things ready in advance. Ask how long it will take before your loved one is back to normal activities.

Sedation or Anesthesia

There are three types of anesthesia:

General anesthesia: The person is unconscious and has no awareness or other sensations. There are many general anesthetic drugs. You inhale some through a breathing mask or tube. Others you get from a shot into a vein.

Regional anesthesia: An anesthesiologist gives a shot near the nerves to numb the area where the surgery will take place. The two most common are spinal anesthesia and epidural anesthesia. Your loved one won’t be completely unconscious, but they’ll probably get a sedative to keep them sleepy and calm.

Local anesthesia: This is usually a shot given to numb only the body part that needs surgery.

Regional and local anesthesia have fewer side effects because they don’t affect the brain. But not all surgeries can be done with these types of anesthesia.

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What to Expect From the Surgery

Before the surgery, your loved one will have a medical exam and some tests. The doctor will rate their physical status. If the results are OK, they’ll sign a consent form and get a surgical clearance. You may sign the consent form for them if you’re designated to make medical decisions.

Your loved one will be told to not eat or drink anything after midnight on the night before the operation so they’ll be less likely to vomit during or after it.

In the pre-op area, they’ll change out of their clothes into a gown. They’ll be asked to confirm who they are and why they’re there. You may need to do this for them. Then a nurse will record their vital signs. They’ll also place an IV line and give your loved one pre-op medications. You’ll want to stay with your loved one during this entire process, and you may need to remind them several times why they’re there and what’s happening.

In the operating room, your loved one will get anesthesia so they don’t feel pain during the operation. After the surgery, staff will move them to the post-op care unit and watch them closely. When they feel your loved one has recovered from the anesthesia, they’ll move them to a surgical ward elsewhere in the hospital or send them home.

During the post-op period, hospital staff will check the surgery site for signs of infection. The doctors will also want to judge your loved one’s general function and the results of the surgery.

After Surgery

You’ll want to be there when your loved one returns to their room after surgery. If they’re asleep, don’t wake them. Not even for visitors. When they wake up, tell them where they are, what has happened, that you’re there, and that everything will be OK. Assure them that they’ll feel better soon.

You’ll also want to build a close relationship with the nurses. Let them know that you’re there to help, and ask if there’s anything they want from you. It will make caring for your loved one easier if you explain how well they usually function and what their normal mental state is. Tell the staff about anything that helps to calm them when they’re upset, in case a situation arises when you’re not there.

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Keep an eye on your loved one’s mental and physical state. If something bothers you, let the staff know. Tell them what you think is different. Know the typical side effects and complications of the surgery your loved one had so you can watch out for signs of trouble.

Talk to the medical team about how to take care of your loved one when they go home. Find out what danger signs you should look for.

If you can’t be there, arrange for a family member or friend to be there. Explain the things they need to watch out for. Give the staff your phone number in case a problem comes up. If you’re the family member who’s most involved in decisions and care, check in regularly when you’re away. Let everyone who stays with your loved one know when it’s OK to call you.

Problems to Watch for: Confusion, Delirium, and Agitation

Your loved one may get frustrated and confused before and after surgery. This may be stressful for you and your family. There’s a lot going on. Your loved might get upset, for example, with all the people coming in and out of their room.

Delirium after surgery is common for older people and those with Alzheimer’s disease. It’s a byproduct of anesthesia and stress. It’s important to stay calm. Remind the nurses to introduce themselves every time they come to care for your loved one. This will help make the experience less stressful for them.

Your loved one may not remember that they had surgery. If this happens, remind them calmly that they had an operation. Let them know what it did and that they’ll get better.

To reduce the chance of delirium, tell them what day and time it is, where they are, why they’re there, who’s visiting, and how long they’ll be there.

After surgery, your loved one may get agitated because they don’t want to stay in bed. They’ll also probably have pain they don’t understand. If this happens, find something to distract them. You can give them a book to look at or have them watch TV. If the nurses say it’s OK, give them a snack.

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Once their surgeon says it’s safe, it’s important for your loved one to get up and moving as soon as possible. This can help prevent problems such as falls, delirium, pressure ulcers, and constipation.

The Purple Angel logo is an international symbol for Alzheimer’s. Let your loved one wear a purple angel wristband and put a purple angel on the door of their room. This will let hospital staff know your loved one has the disease, so they can then care for them with this in mind.

Pain

Learn the signs your loved uses to show they’re in pain. It will also help to learn ways to help manage their pain aside from giving them medications, such as distraction, massage, or aromatherapy. Share things you already know about helping them with the nurses in their surgical or post-op unit.

It’s important to keep a close eye on your loved one to make sure they don’t move the body part that was operated on in a way that they shouldn’t. This could cause more damage.

Follow-Up Care

You’ll need to get prepared for this before you leave the hospital or surgical center. Ask the staff what potential problems you should watch for. Get a list of any changes to your loved one’s medications. Be sure you understand any new medicines and their potential side effects. Ask about the treatments your loved one received, as well as others that they may need. Be clear about any new care you’ll need to be responsible for. Get a phone number you can call at any time with questions. Make a follow-up appointment with their primary care doctor.

WebMD Medical Reference in Collaboration with the Cecil G. Sheps Center at the University of North Carolina at Chapel Hill Reviewed by Jennifer Robinson, MD on August 11, 2018

Sources

SOURCES:

Alzheimer’s Association: “Hospitalization.”

Alzheimer’s.net: “How Are Purple Angels Improving Hospital Stays for Dementia Patients?”

Caring.com: “Tips for Dementia Caregivers: Hospital Do's and Dont's.”

Lewy Body Dementia Association: “Caregiver Tips for Hospital Stays.”

Life Line to Modern Medicine: “Seniors and Anesthesia,” “Tips for Seniors and Caregivers Prior to Surgery.”

National Dementia Support Program, Australia: “Anaesthesia for Older People and People with Dementia.”

SeniorLiving.Org.: “Senior Living: What Seniors Should Know To Prepare For Surgery.”

Best Practice & Research Clinical Obstetrics & Gynaecology: “Surgery in Elderly People: Preoperative, Operative and Postoperative Care to Assist Healing.”

Journal of the American College of Surgeons: Optimal Preoperative Assessment of the Geriatric Surgical Patient: A Best Practices Guideline from the American College of Surgeons National Surgical Quality Improvement Program and the American Geriatrics Society.”

World Journal of Surgery: “Postoperative Adverse Outcomes in Surgical Patients with Dementia: A Retrospective Cohort Study.”

Principles and Practice of Geriatric Surgery: “Common Perioperative Complications in Older Patients.”

American Journal of Nursing: “Dementia,” “Working with Families of Hospitalized Older Adults with Dementia: Caregivers are useful resources and should be part of the care team.”

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