Recovering from anesthesia; we're not seeing improvement as fast as we thought we'd see. Any thoughts?

I would not do the feeding tube at all. Once it is inserted, it can take a court order not to use it. Not for me! I myself don't want a feeding tube as it is the beginning of a cascade of interventions to prolong my life. When I quit eating, let me go! She may be at the beginning of dementia, but she's making the decision to refuse her meds. Listen!

Hi Jeff,
I really encourage you to seek a palliative care consultation. I am a Nurse Anesthetist and I can tell you that even the kyphoplasty will require sedation and the positioning for it is extremely difficult and painful. Sometimes less is more. And the treatments are causing more harm. Comfort care can even get you more days together, interventions can hasten decline.
Best of luck
Margaret

Anesthesia is very difficult on elderly people and they don't often bounce back to where they were prior to the anesthesia. I think she'll need to be assessed for a new baseline.

And I agree with Barb. Get her pain under control. That can only help.

She's in pain from a compression fracture. Start out by treating the pain (patches, injections, kyphoplasty) and see if she comes back to baseline.

Dementia patients are notoriously bad at reporting pain.

I can tell you from experience, it can take weeks for anesthesia effects to be gone. Although you didn’t say what kind she had..I doubt it was general anesthesia but more likely a sedative like Versed. You should find out. Versed can really mess with the memory of elderly...I’m including my 65 yo self in that and refuse to have it.
If she is babbling have they assessed her for stroke? When my dad was on a narcotic for pain after falling and surgery he also was out of it. We need a bit more info. But agree that care conference is needed assuming she’s still in rehab or skilled nursing.

Thanks to all of you for your advice. I wanted to post an update...

Mom still barely eats or drinks. An IV is keeping her hydrated but they want to send her back to rehab today.

Her compression fracture has been painful but they have fitted her with a back brace. They backed off the strong pain meds and are now using Toradol which, I understand, is more an anti-inflammatory. She's six days removed from the morphine. She's not a candidate for surgery.

We tested her again for a UTI and it came back negative. We're a week since the anesthesia used for her MRI (I don't know which one it was but will ask). She's still very confused and sometimes hallucinates but, at times, carries on a decent conversation. It's almost like you can see a light come on in her only to dim again in a few minutes. She does things like fold and refold her pillow cases and rearranges the little table beside her bed. Lots of mood swings. She gets very angry and frustrated at my sis and I only to smile at another visitor.

Mom has a living will which states she doesn't want a feeding tube.

I've been reading a lot about palliative care and hospice. I think our first goal is for Mom to be comfortable before looking to rehab her back. If she's hurting, I can't imagine she'd have the will to rehab. And rehab might just send her right back to the hospital. She's much worse now than when she went in 11 days ago.

I also saw some articles about the late stages of dementia and she has most of the symptoms. Thanks again for all the advice.

Jeff62: My dad had heart bypass surgery when he was 85 & he was a mess afterwards due to the anesthesia - forgetful, seeing/ hearing things, unable to eat or sleep. Characteristics very unlike him. It took about a month before he was himself.  You're mom's been checked for UTI (plumbing #1), but has plumbing #2 been assessed? Even if she hasn't been eating, she may be constipated which can have very negative effects on the elderly.

I agree with Margaret -- sometimes less is more, as in giving you both more quality time. And I too would call for a palliative care assessment.

Sorry to not have followed up on Mom but it's been crazy.

She was taken back to rehab on Monday only to go back to the hospital on Wednesday. The rehab told me they feared she was having a stroke (face droopy, very disoriented). She was rushed to the ER.

When I got there, I saw her state and I too thought she might have had a stroke. But, within an hour of being on an IV, she starts improving. Her tests come back showing she was dehydrated and has a slight UTI. She'd only been in rehab less than 48 hours after being on an IV in her previous hospital visit. The doc said dehydration does add to the severity of dementia but usually not to the levels we were seeing.

I call the Care Manager at the rehab and, sure enough, she'd been given a opioid for pain relief after I had spoken to her the day before saying that we needed to find alternative ways to relieve her pain as she had a reaction previously when given opioids.

Fast forward to now...

Mom is back in rehab. She is eating well. We have a lot of her favorite drinks now in her room. She was on Lasix (I think) because of swelling and we've removed her from that. We're treating the pain with Tylenol and another arthritis meds. Her primary care physician is supposed to meet with her rehab doc and a pharmacist to work out some pain relief options that agree with the long list of her other meds and Mom's reaction to opioids.

24 hours later back in rehab and all is good so far. I'll follow up once I get information on the pain meds they recommend. Thanks to all for the advice.

Mthr has been on hospice in the memory care home. The home provides her meals and the regular services but hospice provided someone to bathe and dress her and put her to bed at night. She had a nurse come every other week and her meds and incontinence supplies were provided. Only things that made mthr more comfortable were done - when they suspected she'd broken her arm, out came mobile xray. With your mom doing poorly, she may not recover from her decline. Personally, I'd rather go on to the other side than to linger, and hospice allows people to pass naturally. They won't try to revive her with CPR and painfully break all her ribs in the process. I think hospice is a good choice.