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Anesthesia Linked to Dementia Risk in Seniors

It may not be dementia. It may be a reaction to a medication in the elderly that LOOKS like dementia.

My father was 87, and doing pretty well for a man 87. He still walked on his own, using a walker when he had to, and very rarely, a wheelchair if we were going a long ways. He went into the hospital for a minor surgery. The tube inserted in his hand for the anesthetic became infected. Dad was acting weird, he was having hallucinations, and my sister rightly identified that Dad had a reaction to the diuretic drug Lasix; when they switched him to an alternative, the raving and hallucinations stopped.

He was transferred to a rehabilitation unit, where for two days, they put him back on Lasix. Poor communication between hospital and the rehab facility, plus standardization of drug regimens – they switched him without telling him, or us. Once again, he went loony tunes, and at the same time, his right hand began to swell until it looked like a lobster claw. He kept saying it hurt, and it was big and red, and the rehab people kept saying it would get better.

Dad was rushed to another hospital, one the rehab clinic worked with, and the doctors told us he had a ‘cascade of problems’ and which were the primary three we wanted them to work with?

Get him off the Lasix, first thing, we all agreed, and find a way to have it annotated on any record that he is never to have Lasix. (It did no good; the next hospitalization, back at the first hospital, they gave him Lasix again, which made him crazy and masked all the other symptoms.)

Long story short, there were a cascade of hospital mistakes – not one hospital, two hospitals and the rehab clinic – where miscommunications, inattentions and shortage of trained personnel resulted in a cascade of issues that led to my father’s death later that year. The other lesson learned is that if you go into a hospital, make sure you have a good support system, someone with you who will bravely ask questions, and remind someone if an inappropriate medication is prescribed. You need a family member with you for protection against inattention, mistakes, miscommunications and personnel shortages.

It’s not like there’s anyone to bring a lawsuit against; they were all doing the best they could, but Dad was old. My bet is that he might have lived another couple years, at the very least, had he not gone in for that first non-essential minor surgery. To me, the moral of the story is if you want to live a long life, stay away from hospitals.

Hospitals-aim-to-keep-elderly-strong-KD14A8TH-x-large

Anesthesia Linked to Increased Dementia Risk in Seniors
Exposure to anesthesia has been linked to a 35 percent increase of dementia in patients over age 65, according to a new study.

By Jeffrey Kopman, Everyday Health Staff Writer

FRIDAY, May 31, 2013 — Caregivers and seniors struggling with the dilemmas of elder care have another risk to weigh against potential rewards — senior patients exposed to general anesthesia face an increased risk of dementia, according to research presented at Euroanaesthesia, the annual congress of the European Society of Anaesthesiology (ESA).

Researchers reviewed the medical information of 9,294 French patients over the age of 65. The patients were interviewed several times over a ten year period to determine their cognitive status.

After two years, 33 percent of participants had been exposed to anesthesia. Most of the exposed patients (19 percent overall) were exposed to general anesthesia — a medically induced coma. The rest were exposed to local/locoregional — any technique to relieve pain in the body — anesthesia.

In total, 632 participants developed dementia eight years after the study began. A majority of these patients, 512, were diagnosed with probable or possible Alzheimer’s disease. The remainder had non-Alzheimer’s dementia.

The gap between dementia related to general anesthesia (22 percent) and non-dementia patients (19 percent) was associated with a 35 percent increased risk of developing dementia. This risk was linked to at least one general anesthesia.

“Elderly patients are at an increased risk for complications following anesthesia and surgery,” said Jeffrey H. Silverstein, MD, MS, and vice chair for research at the Department of Anesthesiology at Mount Sinai in New York City. “[They] are particularly prone to postoperative delirium, which is a loss of orientation and attention. Anesthesiologists have been evaluating higher cognitive functions (for example, memory and executive processing) and found that a substantial number have decreases in one or more of these areas after a surgical procedure.”

Researchers hope this study will lead to more awareness for surgeons.

“Recognition of postoperative cognitive dysfunction (POCD) is essential in the perioperative management of elderly patients,” said study author Dr. Francois Sztark, INSERM and University of Bordeaux, France, in a press release. “A long-term follow-up of these patients should be planned.”

Elderly Care: Risk vs. Reward

Senior citizens and their caregivers might be willing to accept an increased risk of dementia if it means getting necessary anesthesia for an important medical procedure. Dementia is a relatively common occurrence in old age: One in three seniors has Alzheimer’s disease or dementia by the time of their death.

But surgery at old age can also carry more severe, and less common, health risks. In fact, simply surviving surgery can be difficult for elderly patients, especially those over the age of 80.

While the numbers vary depending on procedure, researchers have found that mortality risk tied to elective major surgeries increases with age. The risk more than doubles for patients over 80 compared to patients ages 65 to 69.

But other surgery complications are even more common in seniors.

“The major risk for elderly patients following surgery is pneumonia,” said Dr. Silverstein. “Cardiac complications are next most common.”

However, Dr. Silverstein still feels that if surgery is deemed necessary, patients should not fear the risks.

“In theory, only necessary surgery is done,” he said. “Knowing how [patients] reacted to anesthesia and surgery in the past may give them some idea of their postoperative course.”

Last Updated: 05/31/2013

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June 3, 2013 - Posted by | Aging, Biography, Bureaucracy, Circle of Life and Death, Community, Cultural, Customer Service, ExPat Life, Family Issues, Financial Issues, Health Issues, Living Conditions, Safety, Survival, Technical Issue, Values

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