If you are about to undergo surgery, the doctors will warn you about possible physical side effects during recovery. They’ll tell you how long it will be before you can resume your daily routine. They’ll advise you about medications and give you a list of precautions. But there’s one thing they may not tell you: if you’re an older adult, you have a significant chance of experiencing some degree of cognitive impairment after surgery – and in a fairly large percentage of cases, that impairment may not disappear for months or years, if ever.
That was our take-away from this article we discovered on the website of Kaiser Health News. Written by Judith Graham, the piece is titled, “What We Know and Don’t Know About Memory Loss After Surgery.” Apparently, what we do know is that this frightening condition, called postoperative cognitive dysfunction or POCD, occurs (by some estimates) in more than half of all senior patients and can persist for much longer than seniors and their loved ones are led to expect. What we don’t know is precisely what causes POCD – but, says the Graham article, that may be about to change.
The Kaiser article starts by describing an 85-year-old man who underwent successful heart bypass surgery two years ago. According to his son, who ironically is a UCLA-based anesthesiologist, his father has never been the same since the surgery – instead he’s forgetful and absent-minded, often asking the same questions repeatedly. “He never got back to his cognitive baseline,” says this doctor. “He’s more like 80 percent.” This man, who went from being “sharp as a tack” before surgery to cognitively impaired after surgery, almost certainly has postoperative cognitive dysfunction. However, like the vast majority of patients and their families, this outcome was likely never discussed during the preoperative consultations.
“There is no single presentation for POCD. Different patients are affected in different ways,” said Dr. Miles Berger, a POCD specialist and assistant professor of anesthesiology at Duke University School of Medicine, quoted in Kaiser Health News. Author Judith Graham explains, “Some patients with POCD experience memory problems; others have difficulty multitasking, learning new things, following multistep procedures or setting priorities.” Often the symptoms are subtle and hard to recognize, but they typically develop within days or weeks of surgery. How long the cognitive impairment lasts is anybody’s guess. “Most of the time, POCD is transient and patients get better in several months,” says Graham. “But sometimes — how often hasn’t been determined — this condition lasts up to a year or longer.” One 69-year-old man cited in the Kaiser story sent an email to a doctor conducting POCD research saying he was still experiencing cognitive impairment a full decade after surgery.
Not a New Phenomenon
According to Graham, while POCD was not systematically studied until a few decades ago, doctors have known about the condition for a century. There was a report in the British medical journal Lancet all the way back in 1955 that talked about family members who were “never the same” following otherwise successful surgery. “There are many unanswered questions about POCD,” Judith Graham writes. “How should it best be measured? Is it truly a stand-alone condition or part of a continuum of brain disorders after surgery? Can it be prevented or treated? Can it be distinguished in the long term from the deterioration in cognitive function that can accompany illness and advanced aging?” The Kaiser article says that a major research paper on POCD is due for publication in June, followed by a two-day “POCD summit,” so some clarity (and long-overdue attention) may be forthcoming.
Estimates concerning the frequency and duration of postoperative cognitive decline are all over the map. One 1999 study of patients 60 and older reported that about one-quarter of non-cardiac surgery patients had symptoms of POCD one week after surgery, dropping to 10 percent at the three-month mark. But other studies have pegged the number at a much higher level. A study by Duke University of seniors undergoing knee and hip replacement found that one-third still had evidence of POCD three months after surgery – and that the percentage actually rose to a surprising 42 percent after two years! Doctors also know, says Graham, that those 60 and older are twice as likely as their younger counterparts to experience cognitive decline following surgery. What physicians don’t yet fully understand is whether POCD is triggered by anesthesia or by the stress of surgery, although parallel research seems to suggest that it’s the procedure, not the drugs, that is the underlying cause of the problem.
Knowledge is Power
Here at AgingOptions, the big issue that jumped off the page as we read this article involves patients and their families being left completely in the dark about the very real possibility of postoperative cognitive impairment and decline. “Currently,” the Kaiser article says, “most patients are not told of the post-surgical risk of POCD during the process of informed consent. That should change, several experts advise.” In the words of one physician, “Beyond question, patients should be informed that the ‘safety step’ of not undergoing surgery is theirs to choose.” We agree completely. We would also add this very important advice: as you age, you need a doctor who is well trained in the health issues of seniors, and that means a geriatric care physician, also called a geriatrician. Whatever your state of health, this type of medical professional is your best bet to help you get the care – and the information – you need. Call our office during the week if you need a referral to a recommended geriatrician who practices in your area.
You wouldn’t go into surgery without becoming informed of the risks and alternatives. Why then would you go into retirement without arming yourself with critical information you need to live the life you choose? At AgingOptions we help our clients plan comprehensively for retirement using an approach we call LifePlanning. A LifePlan takes all the vital components of retirement living into account: financial security, legal protection, medical coverage, housing choices, and family communications. These are woven together into a seamless strategy that helps you protect your assets in retirement, avoid becoming a burden to those you love, and escape the trap of being forced against your will into institutional care. A LifePlan is your key to the retirement of your dreams!
It’s easy to find out more: join Rajiv Nagaich at an upcoming LifePlanning Seminar. You’ll find a complete listing of this highly popular free events by clicking on our Live Events page where you can register for the seminar of your choice. It’s all about information, friends! Get started on your retirement journey today by making plans to attend a free LifePlanning Seminar soon. Meanwhile, as we like to say, “Age on !”
(originally reported at www.khn.com)