Is it viable/wise for Dad (84, dementia) to have operations?

[SheWolf]

I'm worried about my father, as he has several health issues that will only get worse without operations, but I don't know how far to go in my quest to maintain/claw back some quality of life for him.

He is 84, has dementia, and has been living in a care home for nearly a year. He is content there, to a point, but his appetite is poor and he's lost some weight over the last few months. He's an alcoholic and used to drink a bottle of whisky a day, but amazingly his heart, lungs and liver appear to be fairly sturdy. He has a couple of beers each day, which makes life tolerable for him.

One thing that worries me is that his mobility has got much worse lately as his hips/knees are worn out, and though operations are available the GA may worsen his dementia and he may not co-operate with the rehab required afterwards. Also, he has cataracts which seem to be getting worse - he can no longer read small print with or without his glasses. I know they don't normally offer GA for that type of op, but how would he cope with it all under a local? If I do nothing, he may be blind and bedridden in a year or so, but if I put him through operations that may all go horribly wrong too. If only I knew whether he has months or years ahead of him, it would be easier to weigh things up.

Old age/alcoholism/dementia has already taken a lot from him, so I want to stop him being robbed of anything more, if possible, but another part of me is saying "don't meddle, you might make things worse". I have asked for the optician to come out and reassess his eyes. His last test was about 9 months ago and normally they only do one free eye test a year but I've said we'll pay if needs be.

Is it worth me speaking to the GP and asking for a referral to a specialist about his legs? In my mind I wonder if his joints are getting to the point they have almost worn away and maybe the next thing will be that he falls and breaks a hip - so do I push for treatment options now, going privately if needs be for a consultation, or should I leave well alone? What would you do?

[Scally]

Make sure he has plenty of whisky at hand, and ask him what he wants to do. If he has reached the grand old age of 84 on a bottle a day, then clearly he has built up immunity: it might be exactly what the doctor ordered, and is probably better than many over the counter and prescription medications.

[bowlingbun]

I have had two knee replacements, so know what is involved. If it was my dad, no way would I consider surgery appropriate. Better to take the pain killers. As for his eyes, by all means have the optician visit, but it may be difficult for him if dad can't contribute to the examination. I'm sorry these comments are so negative. Accepting that there's almost nothing more I can do, to help my mum in the nursing home, is so very difficult.

[Tristesa]

I agree with Bowlingbun. General anaesthetic can be problematic for any elderly person, and when the dementia is factored in, I honestly think it would be better to leave well alone and rely on mobility aids and painkillers for his leg/hip problems.

On the other hand, cataract surgery is (perhaps surprisingly) quite minor, in some ways less scary than routine dental treatment. The combination of local anaesthetic and some form of sedation makes it painless, quick and easily forgotten. Although if his dementia is advanced, he may not be able to answer some of the questions put to him in assessing his vision, many of the salient facts can be established by the ophthalmologist simply by physical examination of the eyes. I am very glad that my poor husband had his cataracts removed in 2012 and 2013. While he was still able to read and take notice of his surroundings, it was definitely easier that he needed only one pair of glasses (for reading). The eye surgery made life a little more bearable for him for a while longer, so it was worth it.

If I had to make this decision, Shewolf, I would decide in favour of the eye surgery, as I don't think it is a major shock to the system at all, and it will certainly improve one aspect of his quality of life. But the hips and knees, no way.

Tristesa

[susieq]

Both hip and knee replacement surgery can be done without the need for general anaesthetic these days - they can both be done using an epidural and gentle (valium based) sedation.

Mum had both her knees done this way and was awake enough to hear what was gong on - she said it sounded like being in a stonemason's yard Her first knee was done when she was in the first stages of dementia and she did have a bad reaction to the morphine used after surgery - kept hallucinating ! The 2nd knee was done 3 years later when her dementia was much more advanced and there were problems with her not knowing where she was and subsequently falling whilst trying to 'escape' the ward

First knee she was pretty good about doing her exercises and got more or less full mobility back - but with the second knee and advanced dementia it was almost impossible to get her to do the exercises because "it hurts" and that knee never did regain the same mobility as the first.

On balance if your Dad didn't have dementia I'd say go for the replacement joint surgery, but add dementia into the mix and it's not such a good idea.

[SheWolf]

Thanks everyone for your responses. The feedback is very useful and really confirms what I already knew, namely that it's probably too late for him to cope with knee/hip ops, but the eye ops may be feasible... just.

Scally, if only I could just let him have the whisky and be done with it, but that's not an option, all things considered. He has never been able to just drink it in moderation and would usually just keep going till the bottle was gone. He often fell over when drunk and sometimes injured/messed himself, so it became impossible trying to care for him. That's why I weaned him off whisky onto beer a couple of years back, but every now and then he would start demanding a large bottle of whisky so I used to try placating him with small bottles of whisky (in addition to beers) but he would get stroppy and say if he can't have a proper bottle he doesn't want it at all! This has all been discussed with the care home manager/owner and we decided that as he wouldn't be content with a tipple we'd just say it's not allowed on medical grounds. However, sometimes I get him a 35cl bottle of port, which he enjoys. At 20% proof it's half the strength of whisky so it's a decent compromise. Alcoholism and dementia is a terrible combination, as he has no memory of all the problems he had and is also in denial that he has a drink problem at all.

In truth, sometimes I think he might have been better off staying at home, drinking his bottle of whisky a day until his liver packed in, but he was a danger to himself and drove my mother to despair. When I searched for a care home to meet his needs, I was very firm that they must be willing to accommodate his alcoholic needs with two or three beers each evening, to make his life tolerable. I've tried so hard to get the balance right between what he wants and what he needs.

I know he's finding his old age difficult and I don't want him to be unhappy. I'm not depriving him of whisky as some sort of punishment (though that's how it may feel to him), but sometimes I feel angry that he let the drink dominate his life to the point where he's now paying the price for his poor lifestyle choices, but acts like some poor victim of circumstance. Dad was offered the chance to go on the waiting list for knee surgery 15 years ago, but kept putting it off, preferring to continue with his pub life. Dad's brain scan indicated that he has unusual amounts of brain shrinkage for someone of his age and there is a direct correlation with alcohol abuse. The thing he prized so highly, above his health and family, has done him far more harm than good. Now others try to make his life tolerable, while he pines for his "lost love". Do you know what I say to that? Tough!!!

[Scally]

There are many good reasons for drinking
And one has just entered my head
If a man can't drink whilst he's living
How the heck can he drink when he's dead?

[Tristesa]

Coming back a bit late to this. Susieq, I hadn't realised that hip or knee surgery can be done without general anaesthetic, so I have learned something new. Nevertheless, I think there is general agreement here that even the post-surgery problems would be too much for your father, Shewolf, in his present condition.

The addiction issue is a hard one, because I don't think any of us can really judge the level of personal responsibility involved in alcoholism or drug addiction. Of course, we all have a choice about starting to drink (or smoke, come to that), but nobody can know at that point whether the craving will remain manageable later on, or will go out of control. And we are usually young and foolish at the point when we embark on these vices, if vices they are.* Adolescents and young adults are not good at looking ahead 40 years, and also, if they have any gumption at all, they like to take risks.

Like many people of my generation, I started to smoke cigarettes and drink alcohol when I was about 16 or 17. I gave up tobacco quite quickly and easily when I was 21, mainly because I felt I no longer needed to smoke to feel/look 'grown-up'. I have continued to drink in moderation all my life. I would miss alcohol (wine) very much if I had to give it up, but I am certain I could do so. It would just be another pleasure taken away from me, and I am getting used to those.

The conclusion I draw from this not that I am a woman of admirable, indeed superhuman, self-control: it is that I am simply lucky enough to lack the propensity to become addicted. I would not want to make judgements about those who are not so lucky.

Tristesa

*I say this because I'm not sure that these things are actually vices. The desire to enter into states of altered consciousness seems to be universal in all human societies, not an unhealthy aberration, but a basic part of our being. Even the smoking of tobacco, which we don't think of as a means to get high, originated in some Native American communities not as a leisure activity, but as part of solemn religious ritual involving prayer and visions. The origins of drinking alcohol are prehistoric, too ancient for us to know the details, but large quantities of wine, the resulting inebriation, together with music and dancing, were integral to the rites of the Greek god Bacchus. The worship of Bacchus also gave rise to theatre. We do not know of any human society that has not used some kind of mind-altering substance.

[SheWolf]

The conclusion I draw from this not that I am a woman of admirable, indeed superhuman, self-control: it is that I am simply lucky enough to lack the propensity to become addicted. I would not want to make judgements about those who are not so lucky.

Same here Tristesa. I'm not judging him, but after a years of putting up with his drunken behaviour and watching the effect of it on my mother, my patience on the whisky issue has run dry. A compromise has been reached, where his needs/wants are balanced against the responsibilities and concerns of those looking after him. He finds it hard to accept that compromise, which is unfortunate, but not nearly so unfortunate as the unhappiness he has caused his family over the years.

Scally, you've had your fun and got what you wanted. Well done.

[Tristesa]

Shewolf, I was not implying that you were judging your father in any righteous way. I have never had to live with an alcoholic, thank heaven, and I can imagine it is utterly vile. I think the approach you are taking now is balanced and sensible; firm but compassionate.

Tristesa