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Nine years ago, my 89 year old young Mom fractured her hip. Over the years, the condition worsened and the ball of hip has deteriorated. Besides just the hip issue, mom is in great health. She takes no meds not even a pain pill. She is a vegan and drinks her green drinks daily. Took her in for Stem Cell consultation but due to the deterioration of the ball joint she is not a candidate. She thinks she is too old to have a hip replacement and fears being placed under anesthesia. The Orthropedic Surgeon adores mom and didn't push the hip issue. In the meantime she is now reduced to a scooter and wheelchair due to old fashion surgery belief and cannot enjoy the quality of life with her family due to immobility. What can I do to convince her to have the surgery?

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While lots of the very old do have successful surgeries you mother's fears are not totally baseless, post­operative cognitive dysfunction (POCD) is a real thing.

"Another Duke study of older adults who had knee and hip replacements found that 59 percent had cognitive dysfunction immediately after surgery; 34 percent, at three months; and 42 percent, at two years." from the Washington Post By Judith Graham
May 19, 2018
(https://www.washingtonpost.com/national/health-science/surgery-can-cause-cognitive-losses-in-some-seniors/2018/05/18/ccc2314a-546b-11e8-9c91-7dab596e8252_story.html?noredirect=on&utm_term=.fdeb284b47cb)
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NeedHelpWithMom Mar 21, 2019
cwille,

Just curious...what is the cutoff age on these surgical procedures? I know my mom has the knee issues and her doctor told her years ago that she would not recommend surgery due to her age.
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This is one area that she needs to be 100%on board if she is capable of making her own decisions. It is part of the patient bill of rights that anyone can refuse treatment. She has a right to make her own poor decisions. What if something happened to her and you were the one who pushed her into it?
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NeedHelpWithMom Mar 21, 2019
I agree!
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I definitely agree this is your mother's decision and if she declines then you need to respect that decision. Anesthesia is documented to cause a dramatic cognitive declines in some people and so far the medical establishment is not able to predict who is likely to be impacted. In our area, one 58 year old college professor was not able to return to work for nearly a year following rotor cuff surgery because she couldn't follow her own lecture notes. My mother had some short term memory problems beginning around age 78 with no real impact until she had two cataract surgeries at age 82. She never really recovered the cognitive ground she lost then. Mom was diagnosed with MCI (scored 26 of 30 and mini then, scored 24 of 30 four years later).

On the other hand, there are impacts of not having the hip replacement surgery and losing mobility that your mother should consider in this decision too. My grandmother chose not to have hip replacement surgery in her mid-70s too. Grandma had osteoporosis, one hip had broke causing a fall and replaced; the other hip needed replacement as the femur continued to collapse on the natural hip while the replacement's metal did not. This eventually caused a nearly 2 inch difference in the level of Grandma's hips and tortured her back. Grandma couldn't stand or walk without pain. Becoming less mobile meant less activity/exercise and contributed to a faster decline in her overall health. With Grandma's pain filled days in mind, I encourage my mother to have joint replacements surgeries as soon as they were needed in mid 60s. My mother had one hip and both knees replaced and was able to recover and rehab fully.

Mom had several surgeries at ages 38, 44, 56, 64 and 65 with no cognitive impacts. So the cognitive decline immediately following cataract surgeries at 82 was completely unexpected. I now suspect the "twilight sleep" drugs used for the cataract surgeries was very different from the general anesthesia used for the prior operations.

Your mother appears to be choosing immobility over risking a cognitive decline as her best quality of life. Please consider that she may be very right in that choice.
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needtowashhair Mar 21, 2019
Cognitive impact from anesthesia is cumulative. One surgery and you are OK. As they add up then the impacts add up. In grown adults, we have neurons to spare before the effects show. There's a lot of redundancy. That's why it takes years of damage from alzheimers to show up in behavior. In young children or older people, not so much. For example, in young children it's been shown that more than 1 surgery does lead to learning disabilities.
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Hi ZeeZee....what does a stem cell consultation consist of? Not familiar with the term.
As to hip replacement......all I can share is that my daughter had both replaced. Due to severe RA scar tissue became an issue and she never gained the range of motion neccassary for a normal gait. That said she is pain free. Different scenario for sure.....but it is hard work once mobility has been compromised prior to surgery and she may never get back normal range of motion. Good luck!
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NeedHelpWithMom Mar 21, 2019
Abby,

PT is hard after surgery too. When I did PT after arm surgery and saw the older people struggling through it after knee and hip surgery it broke my heart.

Sorry your daughter’s range of motion didn’t come back well enough. It is good that the pain went away.
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What is the cutoff age for these types of surgeries? Is it an individual thing or is there a general age when any surgery is no longer safe? My mom’s doc says no to all surgery at 93!

When my mom complained of shoulder pain, (rotator cuff issue), her doc clearly said, no surgery for any reason at her age.
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The older the pt the more they are at risk for complications due to anesthesia. This can be coma, cognitive decline, stroke, heart attack, dying on the table, among other things. Your mom's Dr may feel she is not a good candidate. Remember at any age surgery comes with risk even for the young and healthy pts.

If your mom does not want surgery than you need to respect her decision. She has the right to refuse treatment. Besides think of the pain and the PT she will have to go through. sigh!


NewHelpWithMom,

I don't think there is a cutoff age per say--I think it is up to the pt's Dr or Surgeon. Not sure!
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ZeeZee Mar 21, 2019
Thank you! I really appreciate your response!
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In my opinion 89 is too old for such surgery. Any time a general anaesthetic is used is dangerous no matter the operations. So much recovery time at her age and pain. Memory loss is a big possibility. I think she knows best. There are really cool people mover these days for her to get around and the tiny those scooters are good for around the home. Alternative ways of getting around seem to be better
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ZeeZee Mar 21, 2019
Thank you! I really appreciate your response.
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My late MIL had 3 hip replacements over the span of about two years at age 83 - 85, best I remember. Why 3? Because one failed due to her not lying still immediately after so the glue didn't set properly and eventually had to be redone due to pain and instability. She also had a couple of khyphopasties in her deteriorating spine about that same time. She did fine and after some months of in-home PT was back out running around like it never happened except she had to use a walker for a while and eventually graduated to a cane, which she kept walking off and forgetting! She drove herself anywhere she wanted tp go. She was just as active and feisty and stubborn and busy and opinionated as ever, and that's how she wanted it. At 90 years of age, years after her surgeries, I thought she might be slipping a little mentally ... but was that due to hearing issues? Or because she wasn't eating as well as she should? Her spine was really folding over and inward, leaving less room for her stomach and other organs. She ate less at each meal and I was trying, without much success, to get her to snack between meals. I worried about her weight and nutrition.

All this to say, her surgeries didn't seem to impact her much, and certainly not cognitively. She came through them like a real champ! But when she started not eating well, that's when she seemed to slow down. But everybody's different. I think you need to respect her wishes. If she is spiritual, God will guide her in the way she should go. :) Peace to you, my sister!
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ZeeZee Mar 21, 2019
Thank you very much! I really appreciate your response.
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Don’t push the surgery. Trust her judgement. Also, trust the judgement of the surgeon. Obviously HE trusts her judgement. She is absolutely correct to worry about 1) anaesthesia and 2) about the surgery. I suggest you talk with the surgeon. He knows much more about how poorly elderly persons with Advanced osteoporosis do with this major surgery. It will WORSEN her quality of life, not improve it.
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ZeeZee Mar 21, 2019
Thank you! I will talk to the surgeon.
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Please note, this is the 3rd Orthopedic Surgeon. The first in 2013 and second one in 2017 highly recommend hip replacement. Both surgeons never spoke about the cognitive decline issues or side affects due to her age. The 3rd surgeon accepted mom's decision and suggested fluid aspiration and a cortisone injection. After reading these comments, I have learned, fully understand and respect mom's decision. Thank you all very, very much!😊
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Nope, if she doesn't want it at that age, let that sleeping dog lie. Stem cell is a good idea, glucosimine is a good idea. Surgery at any age is risky and over 70 well...good health or not it is something you want to avoid. Just the lingering affects of the anesthesia are hard and can go on for MONTHS. If she is fine in a scooter and wheel chair, you be fine with it too.

And let me just say that 100 years ago I dated someone who worked in surgery at the VA hosp. I was allowed to see a total hip replacement. That is a memory I wish I did not have. They pretty much ...not detach, but ...for lag of a better term -unstring- your leg-let it back up next to your ear as they are sawing off the bone head. The recovery can be painful and long and hard. WINCE. Let her, at that age, have her scooter and know what's best for her!
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NeedHelpWithMom Mar 22, 2019
Yeah, the recovery is so tough.
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Gosh, just saws this, I get anxiety going to the dentist! I just recently within the last 4 years have had cavities filled!! Yikes... I am a big chicken..

Glad you are listening to your mom and doctor. You can always approach that subject again in conversation.

All I know is we don't heal as quickly as we age. Everyone heals and ages differently. Glad your mom is spry and cognitive. Keep her happy and enjoy her company and fun food :)
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Zeezee, at 93, mom fell and broke her hip and had surgery to replace. She has no cognitive decline. She uses a walker now. The surgery can be great, even for the very elderly, but the bottom line is, it’s her choice.
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ZeeZee Mar 24, 2019
Yes, absolutely! Thank you very much for your response.
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She can have the hip replacement done under local anaesthetic - not nearly as mediaeval and terrifying as it sounds! She won't feel or see a thing, though she will hear rather a lot of carpentry going on :) My uncle had this procedure done in his eighties and his recovery was very quick and complete.

Some orthopods keep little models of joints so that they can show their patients exactly what happens, as well as "spare" prostheses so that the patient can examine what bit of kit is going into her body.

What's really important is to get this done before she loses condition through the increasing restrictions. Don't give up! I hope you're able to get the surgeon on board and encourage your mother to think again.
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cwillie Mar 22, 2019
I also knew a man who had his hip done under local anaesthesia - twice!
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It is not an old fashioned surgery belief. It is very real risk that cognition can rapidly decrease as a result of anesthesia.

Saw it in my mom who had uterine cancer and a hysterectomy at age 80. We hoped that she would return to her base, but did not happen. Her cognition continued to decline. Mom had been diagnosed with dementia, but was mild at time of surgery. Afterward a different story.

Saw it in my stepdad when he had to have revision hip replacement at age of 85. He was very loopy, forgetful and just not at all himself for a few weeks following the surgery. Gradually over the period of a couple of months he returned to his baseline.

Surgery at any age can cause other problems. Much more so as they age. Remember, if mom is competent it is her decision. Post op decline is a very real concern.
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NeedHelpWithMom Mar 22, 2019
My dad had heart surgery in 80’s. Came through surgery but had a stroke while still in hospital recovering. I think surgery is harder on older people.
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I worked with an old WWII vet that had a pacemaker put in under a local. When he fell into and elevator pit he would not have the screws put in or the dented plate in his head replaced.
He was more afraid of the anesthesia than the surgery. He was afraid he would not wake up.
He his since passed away from cancer brought on by the shrapnel still in his face.
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NeedHelpWithMom Mar 23, 2019
Sailor,

Sad. huh? God bless our vets. I get to see my nephew at end of this month. Been in the Middle East 5 times! Thank God he is finally out of the army. Has his years in to get out now. I’m looking forward to seeing him. He has three kids now. By the time he got back home his kids were walking and talking, one had started school. His puppies were grown dogs. His wife made a doll out of fabric that had his photo transferred into the fabric. When her little daughter wanted to hug daddy goodnight she would sleep with that doll. He has a wonderful wife. I love her. I am looking forward to seeing the kids. They are spending a lot on airfare to visit. Cost a lot to travel.
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I would absolutely not have an 89 yo woman even if in “good health “ have hip surgery. She is correct in thinking about the dangers of anesthesia. She will have to undergo physical therapy and the anesthesia can trigger dementia & cognitive decline. She sounds like she still has her marbles so I wouldn’t push her. Unless it’s an unavoidable emergency surgery, skip it!
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How common is hip surgery? What is the main reason hips go out? When is it absolutely necessary? Does the hip get worse without surgery?
89, seems too old to me for this.

My mom mom has the bone on bone thing with knees. Feel badly for her. 93, surgery is out!
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My Dad at age 89 was healthy and active and encouraged by his doctor to have his hip replaced before he was 90. I felt it was an unnecessary surgery since it only hurt while lifting his leg in and out of the car. He elected to do the surgery. While in recovery he suffered a stroke. A risk that is very real that the doctor who encouraged this surgery never discussed in advance. While he pretty much recovered from the stroke it permanently affected his swallowing ability which indirectly caused his death 22 months later. Please research the risks involved and make certain you are making a fully informed decision
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ZeeZee Mar 24, 2019
So sorry about your Dad. The decision is up to mom. Thank you for sharing.
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Don’t know whether you’ve had the chance, but you may have more positive input about wheelchairs and other assistance devices if you consult a rehabilitation specialist.
“Using” a transport device isn’t like the old days. Scout around and see if you can find an expert, if you haven’t already.
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ZeeZee Mar 24, 2019
Yes, mom has a great scooter..which she calls her "best friend"..I just showed her how to increase the speed..😊
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Zeezee, I am so happy to hear that you both are at peace and that your mom is believing that The Lord will heal her hip. You tell her I am believing with her. All things are possible, only believe!

Please come back and share her miracle with us.

Praise The Lord!
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ZeeZee Mar 24, 2019
Yes. I will definitely let everyone know. Thank you very much.
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Don't convince her. In time... If the pain increases, she might eventually agree. Forcing her into surgery sounds as if it's not in her best interest; she isn't in pain..

If she's using a wheelchair or scooter-- how does that affect her quality of life,due to immobility? Rude-yet direct question---Is that a family adaptation issue?
I apologize, the manner in which the post was written makes it sound as if it's an inconvenience issue and not a pain problem..
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