Surgery’s Seldom Disclosed Risk

When surgery is recommended for your parent you know there are risks. But even though you make every effort to evaluate all the pluses and minuses, there is one very important threat your surgeon may not have told you about.

That is the risk of some degree of decline in mental functioning as a result of general anesthesia.

It is doubtful that anyone will tell you that a possible side effect of general anesthesia is a decline in cognitive functioning. This could mean memory loss, an impact to thinking skills, or the inability to complete familiar tasks. The result could mean that even something as simple as playing a game of cards will not be done with the normal quickness and skill. And making seemingly routine decisions could become difficult to impossible. The risks for mental side effects are greatest for people who have some cognitive loss already.

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Post surgery cognitive loss might feel like fuzziness and the inability to think properly immediately after surgery. An older person might complain that they feel like their brain is in a fog. For many older adults this will clear up quickly. For some the fogginess could drag on for weeks or a few months. But, in cases where older adults were experiencing some cognitive loss before the surgery, the result could have long term effects. Even if adults in this final group do eventually recover mental function they will most likely never return to the mental functioning they had prior to the surgery.

Some temporary memory loss and slowdown in thinking is not unusual after surgery. Physicians who study this impact have seen younger patients experience memory loss or foggy thinking immediately after surgery. What is different when looking at this risk for older adults is that this fogginess doesn’t clear up quickly.

It is normal to experience some cognitive decline with age. This will impact most adults in some way if they live long enough. This doesn’t necessarily mean dementia or Alzheimer’s disease. Just the occasional struggle to remember something, or to take longer to solve a problem or learn something new, is not uncommon in advanced age.

But this risk for cognitive loss after general anesthesia is something else.

Researchers endorsed by the American Geriatrics Society have suggested that this problem needs better understanding. Researchers who study brain health are working on this. The Society also encourages physicians to include this risk for mental function decline when they cover the potential risks associated with surgery, especially when older adults are considering elective surgery. It is important to note that the risk for this side effect increases the older a patient is.

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If the potential benefits outweigh the risks you and your parent may decide to go ahead with the surgery. You can help minimize the long-term effects of mental function following the surgery. You can make sure your parent has the following:

  • Glasses and hearing aids are kept close and within reach.
  • Window curtains are open so it is easy to see whether it is day or night.
  • Your parent is encouraged to get up and move around as soon as possible.
  • Alternative pain treatments are used to control pain. If opioids are used immediately after surgery request other alternatives as soon as possible.
  • Family and friends are available to help with reminders and reassurances that minimize the patient’s stress that can result from confusion.

Family member involvement and presence before, during and after surgery can make a big difference. You can provide nursing and medical staff with important information, you can answer questions, and you can be an advocate and spokesperson for your parent.

For additional tips regarding surgeries for frail older adults see: Complex Surgeries Often Have Poor Outcomes for Older Patients

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