He has dementia, problems understanding and seems paranoid at times. He is having difficulty with loss of control and uses me for a sounding board about everything that he thinks needs to be changed. He also has just "Failed" the test to be self medicating. He takes very few Rx meds. He says that the caregiving staff are VERY kind to him, but complains about everything else. He is in a good deal of pain has had Supartz injections and refuses more medication but is thinking about surgery now. I know he does not fully understand the risks of anesthesia, surgery and rehab and post surgery pain. I have been told that surgery at this age can increase dementia and possibly shorten his life. Please advise!

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You have every right to be very concerned. The anesthesia alone is very scary for someone in their late 80's--he may "qualify" for the surgery, just to have NO anesthesiologist agree to be responsible for the "outcome". My DIL is an anesthesiologist and she has refused patients after examining them. In her professional opinion, if they would not have good outcome, she will refuse them.

Knee replacement CAN be done under a nerve block and on mild sedation--however, again, the anes. dr must agree to do it.

The rehab from a new knee is long and difficult. If dad is not 100% on board with the rehab and ensuing change to his life, I'd be against doing it.

Mother whined and begged for a 2nd hip replacement. Her first was a raging failure, she was in rehab for 8 weeks and wouldn't comply. Went from walking with a cane to needing a walker 24/7. Dr. said a 2nd replacement would probably put her in a wheelchair. AND he refused her as a patient and told her to never come back. (Sounds mean, but he said it nicely). She's 88 and a surgery addict.

I'd keep trying the shots and just about anything else to keep your dad going and out of pain.

Best of luck with this!! I's so hard!
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Shelle, I remember back when my Dad, who was in his 90's, wanted to see an orthopedic doctor to see what could be done with his knee. He had bone on bone. Right away the doctor wanted to schedule my Dad for surgery, but Dad said no.

I mentioned the possible surgery to the sports & rehab doctor in my building, and he was all against my Dad having surgery at 90 plus it would take Dad almost a year to finish with rehab. And no way my Mom, also in her 90's, would be able to help Dad with getting him out of his chair or up the stairs.  Plus Mom would have refused outside help.  My help would have been useless as no way could I lift Dad or help him up the stairs [I was a senior myself].

Dad found a pain cream gel that helped him, the prescription was expensive but well worth it. With bone on bone situations, now a days there is a gel that can used between the bones, that has good results.
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I would question the surgeon and others very closely about the rehab needed after a knee replacement. From what I've seen, it's very intense and ongoing (on a daily basis). I'd question whether your dad would be up to it. If he doesn't do the rehab as needed, I doubt he'd regain much mobility as a result. I have a neighbor who was in her 50s at the time of a knee replacement. She didn't do the exercises as prescribed (she was lazy) and didn't return to a good range-of-motion as a result. And she was 30 years younger than your dad.
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My mom is much like your dad. She’s 86, major mobility problems, diabetic and has mild dementia. She’s in assisted living on a very high level of care.

She has a bad knee, bone on bone, only thing left is replacement surgery. She gets by with the occasional pain shot.

In her case the surgery is not worth it. Knee replacement is painful and rehab is not easy. I can’t see mom getting through this. And other than getting to the bathroom with a walker and assistance she is wheelchair bound.
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Even if we were doctors here, it would be nearly impossible to diagnose your dad over the Internet. Only a hands-on exam by an orthopedic surgeon could determine for sure if the surgery would be beneficial and safe. There are no 100% guarantees. Having lived with both chronic knee and hip pain, I can attest to the fact that it has a negative effect on your whole life. It puts a lot of stress on your whole system.

As far as complaining about everything, I understand. Even when deep into dementia, part of us still realizes this place we are is not our home. Even if the people who take care of us are nice and kind, they are not our friends or family. Body parts betray us and don’t work. It’s hard to accept that things have changed, as have we, and we can no longer live the way we used to or do the things we did. As a good friend says, “It’s enough to p**s off the Pope.”

Speak frankly when you go to the doctor and include Dad in the conversation.
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Thank you, I am his healthcare proxy and have POA. I have slipped the nurse and doctor notes but I now see a need to speak with the surgeon privately because my father becomes agitated when he does not understand.
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Very difficult.

Are you your father's health care representative/proxy/POA? If so, and he is considered to lack the mental capacity to give informed consent to surgery, it is squarely your decision. Which sort of helps, but does land you with the buck too... (((you can't win))).

I'd write it all down, and score the pros and cons, and see what marks you come up with for and against the surgery. Have you yourself talked to his surgeon?
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