Experience with Postoperative Cognitive Dysfunction?

[Anonymous]

My 92yo mother had emergency abdominal surgery about 3 weeks ago. She came through the surgery great, and was alert, active, oriented, and moving well. She was discharged to a nursing home after a week in the hospital while she gained strength and her incision healed. About 5–6 days in, she complained about not feeling well, and then took a nosedive cognitively—confused, memory loss, generally disoriented. Basic labs (CBC, urinalysis) did not show infection. This was about a week ago. She physically feels better now, but mentally is still very confused, and aware that she is cognitively struggling.

The doctors at the nursing home have not shown a lot of curiosity about getting to the bottom of this, and seem to be writing her off because of her age. My siblings and I might have bought that if her decline was not so sudden: literally night and day. Nursing staff observed the same. Prior to this surgery, she had what I would characterize age-appropriate mental decline, but still lived independently, managed her own medications, etc. We are at a loss.

In our research, we came across Postoperative Cognitive Dysfunction. This seems to describe what is happening to her, but a lot of the literature seems to focus on the version that is delirium in the days immediately after surgery, rather than the milder form with later onset.

Does anyone have experience with this?

[Anonymous]

Have her checked for a UTI. UTI's in older women cause delirium symptoms. Its very important to get this checked quickly.

As for post surgery delirium my mother suffered this after surgery in her 70's. Its quite disturbing to see. What we were told was, once the person is back in their normal environment they gradual come out of it. In our case, my mom was discharged to a skilled nursing facility vice her normal home environment, so it persisted for quite a long time. She would think people were family members, would tell stories about crazy things, think she was on a cruise ship, etc. To my understanding not much can be done for it, other then the brain needing time to work things out. I am sorry you all are dealing with this.

[Anonymous]

+1 on UTI, also make sure they are not medicating her. Also, it took a relative of mine a month to recover from the postoperative confusion as she was very sensitive to the anesthesia and later the pain medication. Her doctor took her off of all but Tylenol, and she improved.

[Anonymous]

Thanks. We thought UTI, too, but it was clear. Maybe we should try to get her tested again.

Yes, I think it's a neuroinflammation and I'm worried that being in an unfamiliar environment is exacerbating it. But I don't know how she could go home like this.

[Anonymous]

Anonymous wrote:+1 on UTI, also make sure they are not medicating her. Also, it took a relative of mine a month to recover from the postoperative confusion as she was very sensitive to the anesthesia and later the pain medication. Her doctor took her off of all but Tylenol, and she improved.

Thanks. She had a follow-up with the surgeon today and he took her off all the Oxy! But I honestly don't think she was taking much if any as her pain has been minimal by this point.

It's just confounding that it developed 12-13 days post-surgery.

[Anonymous]

Get her home and up and walking as quickly as possible. Sunlight during the day and lights off at bedtime. She needs to get out of the hospital setting. It’s ironically no place to get better

[Anonymous]

Anonymous wrote:Get her home and up and walking as quickly as possible. Sunlight during the day and lights off at bedtime. She needs to get out of the hospital setting. It’s ironically no place to get better

^This. Anesthesia or sedatives have very negative effect on older people with memory issues.

[Anonymous]

She may never recover from it. Hopefully it will improve but don't expect her to return to pre-surgery. To be blunt, prepare for this to be the begining of the end. I know that isn't pleasant to hear, but it's better to deal with the truth. Don't drag her to doctors and subject her to test to find a "cure"

[Anonymous]

Yes to getting her out of there and back to her normal and family environment and routine. Yes to lots of fresh water, fresh food (even if you have to feed her), outdoor time and walking even if briefly. No added meds that she doesn’t need.

[Anonymous]

Yeah I don't want to prolong a diagnostic process, but it was all so sudden. It's hard to get past that.

[Anonymous]

+1 on UTI but also yes post surgical and especially post ICU delerium and confusion is vvvvvv common.

[Anonymous]

Yes, delirium is very common in the elderly. We learned the hard way. Some people come back all the way, some (like my dad) don't. I think it's very hard to predict, unfortunately.

[Anonymous]

I’d be willing to bet it was the oxy. My mom had hospital delirium last year and it wasn’t until I forced them to stop giving her opiates did things start to get better. In her case though she already had some cognitive decline so she never fully bounced back to what she was pre-surgery.

[Anonymous]

FIL had it post heart surgery in his late 70s. It took about 3 months to resolve and was a scary time as we were also told it was hard to say if the changes would be permanent. He had working memory loss and was way more irritable than normal. Would say he was going to do something then we would all
watch him just not do it and then he’d be angry at us for questioning it.

I hope your mom improves!

[Anonymous]

OP what was the surgery for?