After studying the 7 stages of AD, my sister-in-law and I have determined that our 83 year old MIL is probably at the beginning of level 5. She's been suffering with arthritis, especially in her knees, and knee replacement surgery is scheduled for August 15, the earliest date possible.
I've seen a rapid deterioration in her condition over the past several months. Is it possible that this surgery will have an adverse effect on her mental state? Right now she's at her home and one of her sons lives with her. However, it will fall on me to be her primary caregiver after surgery because my SIL is still working and I'm not.
I'm also up for my third back surgery, another fusion, but hope to put it off until she's recuperated somewhat. Any input is appreciated.
If your MIL is in stage 5 and having knee replacement, the scenario will probably run somewhat like my Mom's did.
She was also in Stage 5 of Dementia and livng with my brother, after having lived with me for 5 years. After the surgery (broken hip) she was sent to Rehab for 3 months which was paid by Medicare. (100 days).
After that she was unable to walk, go upstairs, take care of her own toileting needs, and so she remained at the same facility which is a Nursing Home as well as a Rehab clinic.
My Mom has 3 children, but we are all in our early to late 60s. None of us can lift her from the wheelchair into bed, and none of us can support her up a flight of stairs.
Besides that, her Dementia was already making her very hard to live with. During the time I lived with her, she began to wander off and get lost and not find her house, lose money, see people who had died years before, mix up all the names, take her pills irregularly - although I had them in a marked container dosed carefully for the right day of the week. She would take 3 days worth at once, or none at all, and I was working full time at the time.
Moving her to a nursing home was absolutely necessary. And I think your MIL would also be well served if she did that too. They take care of all her physical needs, (she is also incontinent since the operation, but already at home she was having many accidents and not believing me when I told her she didn't smell good). She is well fed, has entertainment and friends, is given her meds by a nurse, and is examined by a doctor about once a week. Thjey wash her clothes, dress her, wash her hair.
We are happy with her placement. It did cost her life's savings for the 3 months before she got into Medicaid, but it was worth it. None of us could have done nearly as much for her as the NH does. Mom is 97.
Welcome! So sorry your family has AD to deal with and that your MIL is facing this procedure. 3 things in what you wrote concern me because of my experience with my mother.
I think your MIL's doctors and PT staff need to put their heads together to decide if she's really a good candidate for the surgery as it is usual and necessary for patients to have rehab. following joint replacement surgery. Her AD may make her recovery from surgery very problematic because she may be unable to participate in rehab. - the AD causes her to forget what to do. This problem with PT and memory was what I ran into with my mother. She was at about stage 6 when she started falling. I requested Physical Therapy for her to improve her strength, thinking that would help her not fall. Within 2 weeks of the start of PT, the therapist said that Mom couldn't remember to do the needed exercises or how to do them so it was useless to continue. My mother was in a wheelchair after that.
Also, it's true that some AD patients seem to lose ground more quickly after surgery or hospitalization, so that could happen to your MIL. As far as I know, there's no way to tell who might react that way.
Last, I am concerned that you, with back trouble, could really be injured by trying to do what your MIL needs you to do. She will likely need someone to lift her or handle most, if not all, of her weight. What does your back surgeon have to say about the plan for you to be the caregiver?! You may have the time, but you don't have a good back. If the knee replacement procedure is done, please consider having an aide employed to do all of the lifting when your MIL is in your care.
It's good you and your SIL can talk about all of this and that you care so much, too. Your MIL is blessed to have you two and sons to boot!
I too would be leery about the surgery. There are many things to consider. Would your MIL be able to comprehend AND follow through with the rigorous demands of PT? Would she be willing? She may be willing now but may not be later. Will she give up and therefore possibly be confined to a wheelchair for the remainder of her days? Will she remember not to turn her foot. If she doesn't, this can result in another surgery. I've seen that happen. Will the knee replacement greatly lessen her knee pain after all is said and done? Knee replacement surgery doesn't guarantee the pain will go away.
Your MIL will need someone who can lift her at all times. What if she decides to try to get up too soon and falls on the floor? With your bad back, will you be able to lift her?
I'm sorry to sound so gloom and doom but these are all things that need to be carefully weighed. Please keep in mind too that some AD patients experience side effects from anesthesia. Among the side effects can be worsened memory loss and anger/agitation/anxiousness.
I was told by an ortopedic surgeon that knee replacement is one of the most difficult surgeries to perform and the recovery process is difficult especially in the elderly. Adding AD to that really can complicate matters much more.
The question is do the benifits outweigh the risks? Based on what you've written, my guess is probably not.
Live, Love, Laugh.
Last edited by LuvMyLilDoggie; 06-28-2006 at 09:28 AM.
I agree with everyone's post - I've had a total knee replacement and I know what's involved in recovery. It is hard, difficult, painful and you must do the PT otherwise you lose the ability to walk (which defeats the purpose of the TKR). I was 47 at the time and I needed help with bathroom activities, etc. With your back I don't think its a good idea for you to be the "nurse".
My mom is at stage 5 fast approaching stage 6. She knows her name, needs help with basic daily activities, doesn't remember my brother (who passed five years ago), nor her own sisters or grand children and usually doesn't recognize my sister or I (our faces) until we tell her our names. At this stage of her AD I personally wouldn't put her through a TKR surgery if she needed one unless her life was at risk (not a statement that can usual be said of TKR).
What does your mom's regular doctor or neurologist say about the surgery? I agree all her doctors should consult on this - it is after all major surgery.
This was a difficult surgery to recover from - from my point of view I'd think twice (maybe 3 or 4 times) before agreeing.
Wow! You've all certainly be helpful with replies and suggestions. Actually, she hasn't seen a neurologist; just her internist who diagnosed her with dementia and prescribed Aricept, which she's been taking for about 1 1/2 years. I don't think the surgeon knows she has this problem. She hasn't recognized it as what it actually is, either, or else she's in a state of denial.