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heydeb Asked February 2017

After hip surgery, depression and dementia got worse, why would that be?

A client with Parkinsons  fell and had hip surgery, she's 84.  her dementia got worse and she is severly depressed and anxious. She has caregivers 12 hours a day but is left alone after 6pm to care for her husband who has alzhiemers . Some nights she gets little sleep because he wets the bed or wants to get up. This happens 3 or 4 days a week. I've talked to her son about this and he says it's not all the time. I know I can't force the issue. I guess until someone gets hurt he'll do something. My question is are there antidepressants or anti anxiety meds that would help this woman? She always looks so worried and any little thing upsets her. She looks like she's in pain.

Shane1124 Feb 2017
Yes definitely agree about the effects of anesthesia on elderly patients. My mom fell & had hip surgery at 86, she was never the same afterwards.
Unfortunately this is very common.
Please speak to your supervisor about your concerns because it sounds like a train wreck about to happen. You owe that to your client to keep them safe.

pamzimmrrt Feb 2017
Many elderly patients show a marked decline after surgury. Anesthesia does linger longer, and I do mean longer. Some never get back to normal. Add in the pain and recovery stress and it can be a long term problem.

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devestatedinco Feb 2017
My mom is 81 years old and has lived the past year in a nursing home. she fell a year ago and broke a hip. She literally was never the same after her surgery. She was a little forgetful before the surgery and trouble walking, but after surgery, her dementia exploded. Her doctor explained that sometimes anesthesia stays in elderly patients brains for a long time. Also if dementia or alzheimers is in the early stages, surgery, can accelerate the problems in the brain. So difficult, as we feel like now we have a completely different person on our hands. Please talk to her physician, to try to get answers. Hope this helps prayers, and hugs

cdnreader Feb 2017
Dear Deb,

Sorry to hear about what has been happening. I wonder if they gave her additional meds for her pain after the surgery and this might have altered her mood. I am also very worried about her added stress and responsibility caring for a high needs husband. If the son will not cooperate, can you call social services? Maybe there are additional community resources they could help this couple stay in their house longer. Or maybe a family meeting needs to be called. I know we all hate change, but in this case, it sounds like there is a serious safety concern with both the wife and husband.

Countrymouse Feb 2017
Heydeb looking back a bit, this elderly lady has been struggling for quite some time, hasn't she? And now she's had a major injury of her own, and her husband's condition will have deteriorated further...

You say the son is - basically - making excuses. How much of the time is he on site with his parents? I note from earlier that he hired you, making him sort-of your client.

I think you're at risk of being quite seriously compromised as a care professional. You've got two vulnerable elders, you're noticing unacceptable risks and pressures, and now you've been fobbed off by the son, who supposedly has assumed responsibility for the situation overall.

Are you a member of a professional organisation, or do you know experienced senior people in your personal network who could advise you about how to proceed? Your clients' welfare is your priority, I'm sure; but you do also need to cover your own backside - this situation seems to be getting out of hand. It seems to be a matter of getting the son to face up to issues that can't be allowed to continue.

The lady client does also have a right to expect her confidences to be kept, I appreciate that. Perhaps you can reassure her that this is a question of ensuring her and her husband's wellbeing, and not of taking over control. Poor sweetie, she must be both exhausted and afraid.

pamstegma Feb 2017
They can no longer live alone at any time. Refer this to your supervisor at your agency. If you are an independent contractor, refer it to social services as elders at risk.

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