Elderly Patients Face Post-Surgery Mental Decline

Simple Measures Could Cut Risk in Elderly Patients

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Oct. 26, 2004 -- After major surgery, many elderly patients suffer a long-term mental decline, a new study shows. Simple measures, like taking anti-inflammatory drugs before surgery, could help cut this devastating risk, the researcher says.

"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, in a news release. Studies show that an abrupt mental decline in elderly patients can lead to lost independence or death.

Monk presented the research at the annual meeting of the American Society of Anesthesiologists in Las Vegas this week.

Earlier studies have pointed to this same pattern of steep mental decline in elderly patients after surgery, followed by a short-term improvement and then a longer decline, Monk says. It's a growing problem since improved surgical techniques and better anesthesia drugs are making surgery-related death less of a medical concern in treating these elderly patients.

"As we routinely and successfully operate on older and older patients, the key issue becomes not only lengthening the quantity of life, but improving the quality of that life" Monk says in a news release.

Better understanding of biological mechanisms involved in this mental decline is necessary, as are interventions to reduce this serious complication, says Monk.

In her study, Monk followed 354 elderly patients about 70 years old, most scheduled for knee and hip replacement surgery. The surgeries required general anesthesia. Each elderly patient was tested before surgery, at hospital discharge, three months after surgery, and two years later to see if mental speed, verbal learning, attention, concentration, memory, and other mental processes had been affected.

The pattern she discovered:

  • At hospital discharge, 59% of elderly patients were mentally impaired.
  • Three months later, 34% of elderly patients were impaired.
  • Two years after surgery, 42% of elderly patients were impaired.

While all elderly patients showed improvement at the three-month checkup, afterward the pattern changed.

Over time, those elderly patients that were mentally impaired at hospital discharge were also impaired two years later, Monk says.

The researchers say the body's response to inflammation likely plays a role in mental decline.

They add that actions that could help reduce this mental decline in elderly patients might include:

  • Giving anti-inflammatory drugs before surgery
  • Controlling temperature during surgery
  • Using regional anesthesia rather than general anesthesia
  • Giving the patient beta-blocker drugs
  • Optimal pain and infection treatment after surgery

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SOURCES: American Society of Anesthesiologists Annual Meeting, Las Vegas, Oct. 23-27, 2004. News release, Duke University Medical Center.
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