Every time my dad (89) with dementia goes to the hospital (4 to5 x) over the last 8 years, they end up putting him on a catheter. In the past they have usually removed it within a week or so, after being out of the hospital. This last time they are keeping it on him. I took him to the recommended urologist, and she saw his past record of this problem while in the hospital and recommended a corrective procedure but the detailed print out I received stated it was risky for his age along with his other co-morbidities, as he'd be going under anesthesia for a bit. The procedure she said would be 60 to 75% successful to correct the issue of retention. Apparently, this has always been somewhat of a problem before he came to live with me (being currently on Flomax and previously Finasteride also). And the catheter does seem to keep his water weight gain down, but I'm just not too sure about this procedure, having read some not so great things on it. Although the catheter, is also a pain to deal with his dementia (and he did pull one out before, and often asks me if he can take it off) . . . I just wish there was a more natural approach or a 75% plus chance, as he's already on a pacemaker also, and the catheter is also more stress for me to deal with due to his dementia. I also think sometimes, as it's a "learning hospital" they may recommend procedures, as practice cases, not that he does not need anything corrective with such, but we did previously experience such incident there with a learning procedure which wiped him out for the rest of the day, but this was like 4 years ago. Thanks for any other more current info about this!
As an old, retired RN, now 80s, I can tell you that EVERYTHING at 90 is a risk because ANYTHING can take us and quite suddenly and quite easily. Or make our lives more miserable, which is often WORSE.
We are now in the QUALITY OF LIFE realm, not the "quantity" in my personal opinion.
So, for me, this decision now rests in
A) what does DAD himself want to do?
B) How busy and active is Dad's life?
C) If an indwelling catheter is the choice, who will monitor for infection, bag changes, management?
D) If things are done and the result goes South, what will be "the plan"?
These are some questions and considerations.
The surgery may lead to incontinence, as well as lead to "being able to go".
The anesthesia is a BIG risk. If there's currently no dementia I would be terribly hesitant at his age to do anything that risks it; it would mean remaining life would be misery.
At the same time, indwelling catheters can lead to infection and sepsis and death as well.
You are between the devil and the deep blue, I am afraid. There's no good answer here. There's no certainty of outcome either way. We all die. SMALL things can easily lead to our deaths, and even a thing so simple as a fall can spell the end.
I guess what I am saying, as an old RN, I am uncertain WHAT my choice would be. And that's why I hope Dad is capable of weighing this all out himself, and deciding his own risk factors, and that you consider the either/ors, and be ready.
And GOOD LUCK. Hard decision!
- advanced age
- progressing dementia
- not high enough success rate of procedure
- high risk of post-op anesthesia-related problems and/or infection
I would not opt for this procedure.
Also, do you even know if it's covered by Medicare or any supplemental health insurance?
I think you are correct about the connection between it being a learning hospital and their willingness to do this on a poor candidate with a low success rate.
I wish you clarity and wisdom as you ponder how to deal with his medical issues and peace in your heart no matter the outcomes.
If it was for something else placing a catheter is common and it would be common to keep the catheter until he is close to being discharged.
I think putting any "tube" into someone with dementia can be problematic. The urge to pull out anything is strong. Catheters, IV's, feeding tubes and so on,
And if there is any possibility that he would have to go to Memory Care facility most will not accept a resident that has "tubes" that leaves Skilled Nursing.
A second opinion might be worth getting.
And my thoughts are 4 or 5 times over 8 years is not a lot of admissions to the hospital (unless there have been other visits and he has not been admitted).
Final thought...I would probably opt to NOT getting the surgery. (for several reasons..his age, other medical problems, dementia) Not an easy decision you weigh benefit VS burden his as well as yours.