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So after 3 weeks in his new digs at assisted living where dad got continually worse, he ended up with being 911 to the hospital who then transferred him to another hospital. He had lived fine, even improving over the past year despite a subdural hematoma. When discovered, the doctor at the time was unconcerned. But it must have started bleeding again and caused a fall or vice versa. The hospital said he was dehydrated as well (so assisted living wasn’t pushing the liquid enough). Anyway. His dementia is worse (likely due to the hematoma) and his balance is off and he’s weakened a lot. But no pain. They want to do surgery which will give him at least two weeks of pain and suffering and of course being in bed so much will require rehab. He already has another heart issue and he and the doctor and I have decided not to put him through another heart procedure, even just a stent ( but the doc thinks it’s another valve). Dad didn’t recover from his other valve surgery 2 years ago which is when the dementia started as well. My question is whether anyone this age sees dramatic improvement from this hematoma surgery?

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I have no experience with a subdural hematoma BUT I would not put a 93 year old through surgery.
If he had been perfectly healthy prior to this I might think about it but with a diagnosis of dementia, heart issues I would not consider it.
With dementia rehab is difficult
With dementia surgery (anesthesia) is difficult. Takes a long time to come back to pre-surgical cognition, if they do.
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I guess I just don't understand why a Dr would even suggest any kind of surgery at his age, unless of course just for the money. I believe at that age it is almost inhumane to put someone through the trauma of it all, let alone the negative side effects from the anesthesia, which can be lasting. If it were me, I would now get hospice involved and let your dad live out his time here on earth in peace and comfort. Best wishes.
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I agree, I would not put him thru surgery. Let nature take its course.

I do need to say something about ALs. They are just that, they assist. Mom's did monitor her weight and her meds. But they are residents not patients. They are living independently with some help. Most stay in their own rooms and just come out for meals. Its up to them or family to make sure they have enough water in their rooms. ALs do not have the staff to monitor liquid intake. ALs are not skilled nursing.

Now Moms LTC did have an aide come around every so often and put fresh ice water on the residents bed tables. I noted too, that if they were out in the Common area that cups of water were given. But this is skilled nursing. Maybe Dad needs a higher level of care at this point.
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lealonnie1 Mar 2021
100% agree with you JoAnn. Assisted Living is not Skilled Nursing, and even in SN, they can't force a resident to drink water! My mother refuses, PERIOD. Unless they were to hook her up to an IV, she's always dehydrated but still alive at 94. Suffers from continual dry mouth too!
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My mom fell in her assisted living apartment and has a subdural hematoma. She was found unconscious in her apartment. We opted not to have the surgery done. She’s 87 and has early stage dementia. She’s been in rehab for 3 and a half weeks and will be moved to a memory unit next week where she’ll get skilled nursing care. I just didn’t want to put her through the surgery. She was already weak, probably dehydrated and I didn’t think she would survive the surgery. Praying you have peace about your decision. This is a difficult season, for sure.
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marydys Mar 2021
Do you know what kind of skilled nursing she will need? I'm asking because even the memory care place here says they don't do skilled nursing. Dad says he wants to try this surgery.
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remarkably he has not complained of a headache or pain at all. I agree it doesn’t make sense. He has had a chronic hematoma for about 8 months with zero issues and the doctor just told me it was normal at his age more or less. Not it had grown and the midline has shifted quite a bit, and he starting having more confusion and weakness. And now they feel this will help him. The doctor said normally in younger people it takes a week to get over the surgery and then however long it takes to rehab. And that often people experience headaches afterwards for awhile. However at his age he would take at least two weeks and because his condition was already poor? Rehab would take a long while. The studies I’ve read online are very confusing and often contradict themselves about success rates. Morbidity etc. the cardiologist says it’s a simple surgery and shouldn’t further cause issues with his heart. What I fear about this Decision is that if I decide not to do it then I will forever wonder if I caused him to die earlier or have less quality of life. I’m horrible about second guessing myself anyway and I really suffer for a very long time afterwards. On the other hand, this isn’t about me, it’s about him. Due to it being a weekend I really haven’t had a real talk with the doctors about this and due to visits he’s having from my out of town siblings, I’ve been staying away So I haven’t really tried to explain this to him and see if he understands anything or even wants to take a chance on the surgery. Hopefully he will feel strongly one way or another and make it easier decisions for me.
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Well, despite the reservations we decided to proceed with the surgery as it is his only chance and HE WANTED TO DO IT. The family was 3-1 but I was waffling a lot. I talked to the doctor that knows him best and he said that he thought dad might do very well... for a while at least. His vitals are very strong so he will linger no matter what. Also from what the doctors say the surgery pain itself isn't that bad (I had that wrong). And my dad generally thrives in rehab.. he's always been willing to exercise. I'm worried about the anethesia effects. However, he's been 'on hold" because his blood isn't thickening quickly enough so perhaps the decision will be made for him. He was so good 3 weeks before this and even pretty darn good the first few days in the hospital..."entertaining" my siblings who came from far away to visit with him. He now is sleeping most of the time which is better than trying to get out of bed. From what I have read, dementia caused by chronic subdural hematomas is considered "reversible" and often diagnosed wrong. I know that is a very small chance but it's a hope I can't help wishing for. His dementia was never that bad and always kind of "different" from other dementia's I have seen. It wasn't short term or long term related and mostly just finding words or problem solving became more difficult. I really think the eating and drinking issues were from the hematoma and not end of life reactions since all the rest of the signs are good. But we don't know and it could be that as well. His advanced directives indicate he wants everything except life support done.
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I can't know what this surgery is. If you are talking the drilling of a burr hole to relieve pressure of the bleed, that is fairly simple and often can be done without anesthesia and can relieve pressure. But you describe something else, that will give weeks of pain and rehab. My answer to that for my own Dad would be NO NO and NO!
Only you can make this decision. But this is going from bad to worse. This is apparently a complicated bleed. If the doctor is being honest with you he will be giving you the odds of how likely your dad is to survive, or survive intact. I would say that they are very small.
Most Assisted Living Facilities don't monitor hydration. Most elders enter the hospital with dehydration at BEST because as we age our drive to recognize when we need fluids is lost. Your Dad may have been in the wrong level of care, though I suspect with a bleed this would have happened in any case. The low BP may have even helped oddly enough, as lots of fluids on board raises the BP and would worsen any bleed in the brain.
I certainly do wish you the best. Only you can decide this with the doctor's input. Myself, as a retired RN, I would never do anything other than the simple burr hole to relieve some pressure, if that. I am so sorry for all the complications. I know you already recognize that this isn't going well, and any efforts are last ditch efforts. I hope you will update us how things are proceeding.
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marydys Mar 2021
Yes I think it’s probably the burr hole but I’m not sure about anesthetic and what type. He’s not in pain now and I would hate to cause pain and for him to lose more quality of life because he was bedridden over recovery time. And it was in his care plan that they would push water. Not measure it but encourage it. Still I’m pretty sure that I’ll be moving him to rehab then a nursing home or memory care next. He was so excited about his assisted living apartment and did the events the first week. But then all downhill. It was hard to know if this was all @adjustment period” or if something else was going on. He was getting more and more weak and confused and not eating much. Anyway he was doing fine prior to the move. I guess I’m wondering if the burr surgery would decrease pressure on his brain and improve his confusion which would help his quality of life (if the recovery went well without pain). But at 93, it is surely a gamble. My sister is against. My brother thinks dad should decide himself. I haven’t sat down to TRY to explain it to dad but will probably tonight. It’s up to me ultimately. He’s doing much better on the IV now and that actually makes this harder because it seems like he could be “fixed”
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We won't even let our 91 yo mother have shoulder surgery. She doesn't rehab well from anything anymore and the care that she'd require post-surgery would be 24/7--and she will not allow 'strangers' in her apartment, think YB's family can care for her indefinitely.

We let the doctor throw himself under the bus by being the one to tell her she could not have the surgery. SO she's mad, but at somebody NOT in the family.

IF this procedure greatly improves dad's overall health--you could try. But anything with general anesthesia--and with the brain--you could have an outcome where, yes, the bleed is contained, but dad loses more QOL.

Sounds like he can't make his own decisions. I personally wouldn't sign off on a surgery like this for mother.
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Dad had the surgery last night and is already a bit better. We thought he didn't really know his sister had visited this weekend but when we told him she was here, he said, yes, twice! He remembered his great granddaughters were on vacation in California. He doesn't remember falling or understand that he's in the hospital or why. But I do still see him in there. He has lost the ability to swallow and can't speak clearly AT ALL (but still has things to say so he tries) and is very weak from lack of eating and being in bed for a couple of weeks. So, it will be an uphill battle but at least he's not just sleeping all the time now (that hematoma was really making him sleepy).

Who knows if he will recover to have some quality of life or not? Still glad I did it so that he has a chance to try. He is not in ANY pain but i don't know if that's only because he's only a day off anesthesia. He's tired of being in bed etc.

This last week we were going day by day and he was doing worse and worse and the nurses were all dropping little comments about how a 93 year old with dementia shouldn't have burrhole surgery. I nearly cancelled it because it seemed his brain was further damaged. But he's still in there and I know he will work on getting better if we can only keep him nourished. Feeding intravenously isn't something we can keep doing for long... and the nose tube wasn't an option because they were seeing him pull all tubes out when he was agitated.

Anyway, just thought I'd tell you that we are glad we tried this and hopeful that he will get back to where he was before the fall.
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