Your Risk of Post-Operative Cognitive Dysfunction

What if mom's still confused after surgery and rehab?

When it happens, seniors and their families are faced with difficult decisions about long-term care. If memory loss hasn’t cleared after rehab, they wonder if it will be permanent.

Families ask if they should move mom or dad to assisted living or a care home? What if mom just needs more recovery time? If dad moves to assisted care and then makes a full comeback, must he move again?

What are the signs of Postoperative Cognitive Dysfunction (POCD)?

After surgery, older adults can experience increased forgetfulness, difficulty learning new things, following multi-step processes, and prioritizing tasks. Speech is also commonly impaired.

Often, POCD can be temporary and older patients get better within several months. But sometimes the condition lasts up to a year or longer.

Several research studies were done to determine the percentage of elderly affected by POCD. The answers aren’t definitive other than proving there is a correlation.

Are some elders more likely than others to have permanent memory decline?

Several factors contribute to an older adult’s risk of permanent memory loss after surgery. They include:

• Being 60 years of age and older,
• Having a lower education level,
• Had some cognitive issues prior to surgery,
• Had a baseline of undiagnosed dementia,
• Cardiac event vs elective surgeries such as hip and knee replacements.

What causes POCD?

It’s unclear what’s responsible for POCD. Until recently, anesthesia was tagged as the culprit. More recent evidence implicates the stress of surgery as the cause.Are some elders more likely than others to have permanent memory decline?re some elders more likely than others to have permanent memory decline?

What does it mean for you and your loved one?

• Discuss the pros, cons, and possible outcomes with your loved ones.
• It’s imperative to get or give signed POA prior to surgery. In case you or your loved one experience POCD, someone needs to pay bills and make decisions.
• Make sure you and your loved one get a lot of information prior to the surgery. Talk to others who’ve had your type of procedure.
• Feeling positive and in control quells fears and anxiety which reduces your risk.
• Learn meditation and relaxation techniques.
• Identify if you or your loved one is a high-risk for POCD.
• If you’ve had concerns already about memory issues, discuss your concerns with the surgeon and anesthesiologist. Get a neuro-cognitive evaluation to establish a baseline.
• Discuss surgery options like nerve blocks.

What about making long-term care decisions?

If you feel you or your loved one is high risk for longer recovery or permanent POCD, take these pro-active steps:

• Contact a local referral agent.
• Discuss options for both long and short-term care after rehab.
• Learn about the differences between care settings.
• Discuss the financial pros and cons of different settings.
• Ask about communities with graduated levels of care. Some facilities have Independent Retirement and Assisted Living together on a campus setting or within one building.

Finally

Surgery is good. It improves quality of life. The number of people 60+ having surgery is on the rise. Unfortunately, a common side effect of surgery is impaired cognition. Almost half of older adults end up with forgetfulness and cloudy thinking afterwards. The condition can last for weeks, months, or years.

If you or an older loved one anticipates having surgery, be prepared to make difficult long-term care decisions – “just in case.”