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Question: My 78-year-old dad is considering hip replacement. I
am concerned that general anesthesia might cause his mental
state to deteriorate. My mother was never the same after
surgery. She had hallucinations and paranoia, signs that my dad
sometimes shows already. What are the dangers to the elderly in
general anesthesia?
Answer: Most older people who undergo hip (or other major joint)
replacement are glad they did. Arthritis might significantly
limit an older person’s mobility. An older person with severe
arthritis in the hip might no longer be able to walk, exercise,
or have intercourse comfortably. Blood pressure and blood
glucose might be more difficult to control. Muscle weakness and
pressure sores might develop in extreme cases. Hip surgery could
possibly change your father’s life for the better.
It sounds as if your mother had delirium after her surgery.
Delirium is a sudden alteration in mental status, which is seen
in at least 1/6, and perhaps 1/3 of adults over the age of 65
who are hospitalized. Older adults who are cognitively impaired
(problems with their memory) and who are sensory impaired
(especially from low vision) are particularly at risk. The
medical and psychosocial stresses of hospitalization cause the
confusion. Examples of these stresses include fever, sleep
deprivation, immobilization, unfamiliar environment, medicines,
chemical abnormalities, infection, stroke, alcohol withdrawal,
urinary retention, and fecal impaction. Even if spinal
anesthesia is used, as is common for hip surgery, other stresses
in the hospitalized environment can cause delirium. Although
most people do return to normal, it can take up to eight weeks
after discharge from the hospital to return to the
pre-hospitalization state.
The risk of delirium in the hospital can be reduced by
frequently re-orienting the individual, avoiding unnecessary
instrumentation such as urinary catheters, monitoring medicines
carefully, ensuring adequate nutrition and supplementing meals
with frequent snacks to prevent dehydration or malnutrition, and
having the individual get out of bed early in the hospital stay.
Making sure that the patient has his or her glasses and hearing
aid is important to keep in tune with the environment. A quiet
hallway, relaxation tapes, and a cup of warm milk or herbal tea
before bedtime are better than using a sleeping pill, which
might contribute to confusion.
