Has anyone taken their parent to a hospital from long-term care to have cataract surgery? My mother will likely need to be restrained. Thoughts?

First, what is Mom's life expectancy? If she has conditions that are likely to limit her to a few years (3 or less) and she still sees enough to function you can skip surgery. Using a dilating eye drop may allow her to see around the cataracts (one drop of atropine 3x/week). This will also let you see how compliant she will be with the eyedrops. If she fights it she will need to be sedated with oral medication to administer eyedrops. Please do not consider cataract surgery without proper post-op care. There are alternative to eye drops (medication implants) and this can be discussed with her ophthalmologist.

Yes, I have taken my mother from ALF to hospital for cataract surgery. The staff at AL was excellent. They took care of my mom during the eye drop phase and now she sees the photographs of her grandchildren across the room. The surgeon was very helpful to me by making sure all the necessary paperwork was filled out for the AL staff. The staff at the hospital was ready for an elderly lady with many health issues. She was sedated. The hard part was getting her there because she doesn't move much. She still wears reading glasses. It was worth having the surgery. Her life is better. The sad part is that my mother suffered for years with poor vision due to cataracts because she rarely went to get an eye exam.

merlerose: Imho, speak to the head of the facility regarding this issue.

I would have a care plan meeting with her team in long term care. I would ask how many times they have helped with after care with this surgery and also their opinion as to how your parent will do during after care. If your parent has dementia and it is advanced, there could be issues, but if they are mainly in LTC for another condition, the surgery could greatly improve the quality of their daily living and could give them a real boost. Improving eyesight so that they don't have to rely on glasses that may be out of reach, or get misplaced, or be just plain dirty and they can't get to the washroom to clean them could be really appreciated. The nurses at the LTC can administer eye drops as they do all other medications so that shouldn't be a problem, although if it were my parent, I would try to be at facility more often during the first day or two to make sure that the drops are being given in a timely fashion, particularly if you parent's short term memory is compromised and they can't keep track of the drops schedule themselves. If your parent schedules the surgery, I recommend that she/he have a good manicure to shorten, clean and file their nails before hand to minimize any possible injury or infection. Cotton gloves or mittens for the first few hours post-surgery might help?

Dementia brings neurological changes to eyesight. I would suggest discussing the need for cataract removal with her neurologist or gerentologist. If she doesn't have either or those, perhaps the Alzheimers Association could help you understand more how dementia effects visual processing, so you can make an informed decision.

My 93-yo mother may be in that situation, as the cataract in her better eye is pretty severe. So as others have said, it’s a matter of contributing to quality of life. Dementia is awful enough without being blind. I have had cataract surgery myself, and was not restrained, although my head was stabilized in something so that it would have been difficult to move. My sister may be able to get permission to be in the surgery suite with our mother, which would help a great deal, but I’d like to have it done even if she couldn’t. Pay attention to CindyO’s positive comment. And keep in mind that some people make alarmist conjectures without adequate information.

I wouldn’t bother if they can still see with glasses on. They need eye drops put in quite frequently.

My thoughts are simple -if they have dementia and they act out and don't cooperate - and something must be done that needs to be done for them, then they must be restrained - they have dementia - they will rant and rave if you do something or you don't - so restrain them.

Perhaps what you need is to hire a few days of in-home caregivers.

I have worked for over 35 years in ophthalmology and it is worth having your mother's cataract surgery done. I would imagine that poor vision can enhance the problems of dementia. If you are concerned please speak to her eye doctor. At times we have had to use general anesthesia to be sure that the patient does not move. Typically patients are given something to relaxed them and that works just fine but for your mother I would be sure that all avenues are discussed. Cataract surgery is done on patients with many different diseases and if she is going to the hospital for her surgery they will know how to keep her safe.

It's always worth getting done. No one deserves to go blind because they're behavior is inconvenient.
I don't know if the eye doctor told you this, but everyone is restrained when they get cataract surgery. They are also given anti-anxiety medication or sedation. My mother had cataract surgery done twice. She doesn't have dementia or live in a nursing home. She was awake both times and was restrained. She was sedated and it was fine. Your mom will be just fine too.

My mom, aged 96 and with dementia, had both cataracts done separated by one month. Hated to put us all through it but in her case cataracts were making glaucoma worse and she was at risk for a sudden, painful, serious occurrence with one eye, plus possible blindness. Her eye surgeon recognized her inability to follow “staying still” during surgery so we opted for a type of anesthesia that completely immobilized here eye (a tad riskier but safer for surgical outcome). She came through both surgeries perfectly thank goodness! Won’t lie though, the two- week after care was very tough due to her dementia. (She and my dad live alone in own home with help from me.) I had to move in each time for two weeks to manage eye shield (so she wouldn’t accidentally rub eye), complicated regimen of eye drops, and constant reminders not to bend over (Mom is agile, fast and loves to clean so that was hard!!). We also hired an aide to help us so I could get a shower and some breaks!! We got through it and now her vision is much better and her glaucoma much improved and no more risk of that sudden trauma!

My mother developed inflammatory breast cancer at the age of 93. She was still of sound mind, and she opted NOT to treat. It was so difficult watching this cancer eat up her body, but there is no way I could have gotten her out and about to treat for this. She was on hospice already and they came to the house for dressing changes often.

The moral of the story is that there is always the procedure which could be painful and also the follow-up care. This could take her down more. We stopped all my mother’s visits to the ophthalmologist for her macular degeneration and glaucoma, plus cataracts. More torture for her to endure and she just made-do with what little eye-sight she had left. Tough decisions that are hard on them and the care-givers.

how old is your mother? does she have dementia? is it worth having done, can she still see? what does she do in the facility she is at OR is she at one or at home? if she does more sleeping than anything I wouldn't bother. I am sure they could put her to sleep or partially asleep so as to not have her move. Both my parents had eye surgery done (prior) to dementia but they never had to have eye drops every hour after the surgery (as some have posted, so I guess it depends on what else is going on with the eye).....too many things not known to provide a good answer. Talk it over with the eye surgeon to see if worth the hassle (so to speak). wishing you luck.

With my cataract surgery there was some kind of restraint; I recall having to ask someone to scratch my nose so I wouldn't sneeze during the procedure. My eyelids were "propped" open, but it was up to me to move or not move my eye around, as instructed by the doctor. Afterward, there was not only the antibiotic/steroid drops at regular intervals, but also moisture drops every hour while awake.

My question as well. My mom punched eye Dr in stomach with both fists and slammed eye machine against wall when he did something she didn't like, that hurt. She has one eye with huge cataract, but 84, dementia... Is it worth it? Ppl mention quality of life and I agree but what if whole is too much too? Then, no life? I understand all your questions, then I worry about pandemic issues too. I can't give u answers because I cannot seem to figure it out either. I can empathize with the worry and stress that comes with this question. I appreciate hearing what others say on this too. Didn't think about aftercare, eye patches, not touching her eyes. I am her caregiver, I work at home. I have 30 hours a week of help from state with copay. I would need 24/7 care at home and cannot afford that either. Ugh. It seems to create a lot of new problems in the short term just for aftercare. Answers you received gave me even more to consider. Good luck.

I don’t think it’s worth risk to your mother’s well being!
you need to keep very still and follow a lot instructions schedule 3 different drop prescriptions for about a month … then schedule the other eye …
the older and longer the patient had cataracts the much more difficult the surgery .. I suspect your mother has
had cataracts for awhile.. now she has dementia and has to be restrained for surgery .. she’s not driving … cataracts not her worse problem .

Nend more info.

Why must mom be restrained?

You can have cataracts for years before needing surgery.

Has the eye Dr said it's time?

They only do one eye at a time and if mom has dementia, she's not going to be able to not mess with the eye once it's been operated on.

If she has dementia I will live alone, even though I have to put drops on her ice every hour.

My mom is 92 years old. She had cataract surgery on one eye 15 years ago and had not had the other eye done and so it was affecting her perception and balance. When she moved near us I took her in to have the other one done … she kept asking why ??? I’m 92 ! She’d say … well - big mistake! At 92 cataracts are hard and crusty and need to be chiseled out. She couldn’t see at all out of her eye for six weeks and needed eye drops put in seven times a day! Three months later she is seeing better but still needs eye drops twice a day. Think about it carefully!

What does mother say? Does she understand the procedure and that the restraints are to ensure she doesn't move suddenly and the surgeon cause her some eye damage? Has she been shown how the restraints work and how the operation will be done?
If not then explain it to her (or get the medic who should have done so already to do so). If she is not able to understand due to dementia or cognitive decline then talk to the planned surgeon and see if they can use a light general anesthetic instead of local and a bit or sedation, and how she will cope with the after care -which is not strenuous but may cause stress to your mother if she doesn't understand.
You do not say how old your mother is or what her mental capacity is. But it is also worth considering how much this operation will improve her quality of life which can be dependent on mental capacity. I am not suggesting we should leave people to live with cataracts just because they are in long term care, or getting old, the operation makes a huge difference to standard of life for many many people, but every case has its own "differences" which need to be taken into account as well as the simply improved vision ones.

Usually, every person is given a mild anti-anxiety medication and a mild sedative so they are sleepy and extremely cooperative. Let the staff know about your mother's health issues so they can make accommodations.

Ask about follow-up care after her surgery and if this will be a problem with her other health challenges.

My first question is why.
Does she need to have an elective procedure ?
Does the doc understand the severity of the dementia and her ability or inability to be involved independently with her post op care?
Will her quality of life be significantly improved by having her cataract removed or will she still have a terminal disease?
Who will be liable or responsible for her care post op?

Just a few nurse questions.
Will be thinking of you, best wishes

I was lightly sedated
BUT...and this is a biggie.
She has to be able to follow instructions during the procedure.
Yes you are sedated but it is a very light sedation.
Your arm and legs are somewhat restrained. IV in one and a BP cuff on the other.
IF she has dementia I would hesitate about having the surgery. There can be complications. There is a real lag time when recovering from the sedation. Even longer if there is dementia involved.
You do not indicate what her medical problems are but even though it is a relatively easy surgery it is still surgery and there can be complications.
The biggest question is...
Will the surgery improve her quality of life enough that the risks are worth it.

I was given a sedative each time—they did one eye at a time. I woke up being able to see because the new lenses also did major vision corrections. If she’s sedated enough she may not need to be restrained. If she’s battling the process that much it could make the doctor’s job a lot harder. Not to mention the at home aftercare. Has she requested cataract surgery or is it someone else’s idea? Speak with the ophthalmologist—they may have input that answers your question.

Also she will need to be prevented from rubbing her eyes for several days after surgery.

This all depends on your mothers health and age. If she has Dementia, not sure if I would have them done. She will need to sit still. A local anesthetic is used. Some have patches afterwards. Will she keep it on? Then there are the drops before and after. Will they be given regularly by the staff?

You need to talk to the ophthalmologist doing the surgery.

I had cataract surgery on both eyes near the end of 2019.  If I recall correctly, I was restrained, but it wasn't anything drastic, just belts over my arms and chest to keep me immobile.

The anesthetic completely numbed any feeling; I was semi-conscious, enough that I could see beautiful star like scenes, as if I was staring into space at a collection of planets and stars.   I remember thinking that I needed to figure out how to capture that image as it would make a beautiful quilt.

The issue already raised of the need for eyedrops is something to be addressed. 
My regimen was 4x daily for the first week, dropping down to 3x, then 2x, then 1x over the next 3 weeks.    If your mother has both eyes done, the doctor (and depending on her health) may perform the second surgery 2 weeks after the first, assuming all goes well with the first surgery.   That was my situation.

I think you need to have a discussion with the long term care staff (DON if possible) to determine if they can or will give the eye drops.  It's critical that they be given, so the commitment on the facility's part needs to be serious, not just if they have time.

A discussion is also appropriate with the doctor performing the surgery;  I had pre-surgery discussions so I had a good idea what to expect (the starry skies were a surprise though).  

I will warn you; the drops sting.  My ophthalmologist told me they contain an anti-biotic or something (can't remember fore sure) that prevents infection, so the drops are critical.

Since it came up again recently in my world, just to mention that in my dad's case it seemed when he had it done they restrained his head so I don't know how that will go down. Surely she will have been seen by the surgeon prior and he and staff will be aware of potential risks/issues to plan accordingly. I will just add that there is a product called Kind which is a silicone tape made by 3M (sold at the woundcareshop.com and I believe on amazon as well. IT does not stick to hair and is far gentler on older skin but would seem some of these health care facilities are too cheap to buy it and keep their elder patient's comfortable if not safer. It is a small price to pay even if one gets it out of pocket. My dad has very hairy arms. It was almost like they used duct tape to secure the IV line the first time he had a cataract done and a sadistic nurse in spite of my loud announcement as she approached and began to try and get the tape off that if she would bring me a small scissors I would work at it (we'd done this before...yes it's time consuming but can be done,cutting between the tape and hair on the arm....) She just ripped it off while he was still on the BP monitor and you should have seen the BP spike! No reason for it. Hopefully all will go well....

My mother and MIL had cataract surgery, but were quite compliant. I’ve recently had 2 eye operations. The eye ball is held in special spoon-shaped tweezers that immobilise it, but that don’t stop bigger body movements. If the surgeon knows that she is at risk of movement, she might be given a sedative, or even the mini-anesthetics that put you out for just a few minutes (common in colonoscopies). I’d agree that drops aren’t always easy to self-administer – will she have help for that?