My 97 yr old mother has moderate cognitive decline. How can I tell if she is competent to make a decision regarding hip surgery?

Good Grief, operate on a 97 yo person who has dementia? Makes no sense to me.

I would go pain management, and I would switch doctors.

My mother is 98, her mind is good, neither she nor I would go forward with any kind of surgery at her age,

She is not in a mental state to make any sound decisions, she will not understand, I would let it rest.

I think there's a doctor's ego at work here if he's even suggesting that kind of surgery on a 97-year-old. Just the anesthesia will likely accelerate the cognitive decline, which will lead to her being unable to do the physical therapy properly, which will lead to her becoming wheelchair-bound.

All that for the chance that she MIGHT have less pain which, considering all the factors above, is a gigantic MIGHT.

I vote for pain management over surgery.

I don’t think the surgery is in your mother’s best interest. I doubt she would be walking again with this surgery. I also think at 97 keeping her comfortable and pain free is the priority. These surgeons just want to make their money.

I like Lea's suggestion about having a local. So its not so much the surgery that bothers me, its the Rehab. I would not do it in a facility. PT/OT is maybe 2 hrs a day, then the rest, they sit in a wheelchair. In Moms Rehab, activities were a laugh. Aide asking Mom if she wanted to make a card, what!. She is in her last stages of Dementia she probably has forgotten what cards are.

I don't think mom has the mental acuity to make this medical decision.

If you choose to go ahead w full hip replacement, know that mom can likely have an epidural INSTEAD of general anesthesia, which is far less dangerous in general. That's what I had with my hip replacement. I chose some Propofol to knock me out bc I didn't want to hear sawing and scary sounds. The surgery itself took 90 minutes, left me with about a 4" scar on my leg, and they had me up and walking that same day. I had little pain from the surgery, and my rehab was lots of walking, nothing else.

I needed a lot of help from my dh bc it's very hard to move around in bed after THR. It feels like the lower body weighs 300 lbs, is the best way to describe it. I needed help getting to the bathroom, where we installed a hi riser seat with handles. You cannot bend over at ALL to pick anything up or put socks on etc. I was 55 at the time of my THR so you can't compare my outcome with that of a 97 yo with dementia. I was driving and back to work in 3 weeks, no pain at all w the new hip.

I think if this were a decision I had to make for my mother who had dementia, I'd choose to up her pain meds. There is SUCH a level of confusion w dementia and inability to follow instructions that I think it would be too much of an undertaking for the woman.

No good answer here, for sure.

Best of luck with a difficult situation

This is a terrible decision to have to make. Terrible. On the one hand you are left with increasing pain meds and increasing falls. On the other, the dangers of anesthesia alone can send her reeling from partial loss of faculties to full dementia.
I honestly do not know how to answer you. I think that I would opt for the increase in pain meds, and I might try palliative care and hospice now. It seems she cannot answer the question. You are left with your best instinct and I would say that whatever choice you make there is no good decision here, no decision without constant risk. She is 97. That says it all. It isn't a fool's errand, but it may just be a situation with NO GOOD ANSWER. My best to you, and I am sorry for this tough decision. I would consult with her regular MD about this, not just a surgeon; cutting is what he does.
So sorry. This is a tough one.

No doctor should encourage anyone your mothers age to have surgery as they are more than well aware of the many risks. Most notably is the effect that anesthesia has on the elderly, especially an orthopedic surgery. It's been proven to cause dementia like symptoms and dementia itself that sometimes go away but more often does not.
I would just keep your mother as pain free as possible and not put her through any more medical procedures. And if need be, bring hospice on board as they will do their best to keep her pain free and comfortable.

Is the point to regain her mobility? Or to address the pain?

Her mobility wasn't good before her 2 falls. A hip replacement (and the PT that will then require her full participation) will NOT regain or improve her mobility.

Address the pain and keep her as comfortable as possible. If this lands her LTC, so be it. Talk to her doc about managing pain in the long-term. I'm sorry both of you are going through this. There's no "right" solution... only a least bad option.

I would take heed from the slow healing she experienced before, anything that’s happened previously has an increased chance of recurring, especially considering her age

I think moderate cognitive decline makes her unable to make this decision.

My MIL is 96 and I would suggest to my husband NOT to do it. It's too much. I would do whatever is possible without surgery to keep her comfortable.

At this point is she able to be active at all? If so, has she had PT?

Best of luck.

From what you describe, you’re the one most competent to make the decision. After the hip replacement, there’d be rehab. Would she be able to withstand that? Ask what would be involved. Also the possible delirium after the anesthesia needs to be considered. And then if the anesthesia causes more cognitive decline and she doesn’t understand what’s happened, you’d have to deal with that. It’s a tough decision. I’d be inclined against surgery at age 97 because you don’t know what you’d be dealing with afterward, but at least you know now.

My 97 year old aunt broke 2 bones in her lower leg when dropped by caretaker a few months ago. Doctor wouldn't operate because she wouldn't survive the operation. She's healing just fine. Her goal is to be 100.

I am sorry that your mom is in pain. I would be very concerned about her having surgery at her age.

When my mom was in her 90’s her doctor said, “At your age, absolutely no surgical procedures for anything.”

Best wishes to you and your mom.