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cateract op. in advanced stage of Alzheimers

Discussion in 'ARCHIVE FORUM: Support discussions' started by Jane L, Apr 6, 2004.

  1. Jane L

    Jane L Registered User

    Apr 6, 2004
    My dad is in the advanced stage of Alzheimer's but still has a good quality of life at home/day care and is very physically fit. He's worn glasses all his life but now we're told he can't have new ones because he has cateracts.
    He's referred to the hospital. They first lose any record of the referral and then put him on a year long waiting list. Finally he's given an appointment. They won't do anything till he's had an eye test. Dad doesn't know what they are on about when they ask him to read the letters out - they show him bigger and bigger ones. He can see them, but he doesn't understand the question, let alone what the concept of 'letter' is or what its name might be. Mum attempts to explain this to the assembled experts and nurse. The opthalmologist chap gets annoyed, cos he's not got any bigger letters. Mum gets annoyed, Dad gets agitated. So finally a consultant is called, who looks in dad's eyes and declares that there are indeed cateracts and they are ripe for operating. Everyone is in an agitated state by now and the consultant says he could operate but 'only if Mum really wants to put him through it', giving no indication of what that realistically means. Mum replies that she doesn't want him blind either, and no one will even prescribe glasses because of the cateracts. Vicious circle.
    Does anyone have any personal experiences of going through a cateract operation on someone with Advanced Alzheimers?
  2. John Bottomley

    John Bottomley Registered User

    Apr 7, 2004

    If done thoughtfully, with time to reassure and explain, then even if information's not retained he should be able to make it through the process feeling at best pretty content and cared for, or at worst fairly indifferent about why people are doing x, y and z that he sees as irrelevant or unnecessary.

    The biggest factor I've seen in making such surgery workable is a compassionate and thoughtful team. Rushing the process just leads to confusion, anxiety, helplessness and profound distress.

    The quality of life gained from good vision is, obviously, pretty significant.

    In dementia, when folks mis-perceive and mis-interpret what's going on around them all too easily already, it's well cited as good practice to improve their senses (and reduce sensory problems in the environment around them) so rather than a barrier to cataract surgery, the presence of dementia is a positive indication that it should happen to help him.

    Overall it's a call on quality of life. Cataracts aren't painful. Cataracts don't cause harm or kill you. Cataracts can be left alone. So the surgery is being done not to save life, but to improve quality of life. Vision being so very important, it would seem sensible to try and discuss how surgery could be done with the minimum of distress to him.
  3. Jane L

    Jane L Registered User

    Apr 6, 2004
    Many thanks John, for your helpful reply regarding cataract surgery and the need for good sight.
    I have been making some phonecalls today and have spoken to the hospital which did the last assessment of my dad's sight. I also spoke to the ward sister of the day care centre he attends to get advice from someone who knows him well and also knows other patients with Alzheimer's who have had the surgery successfully.
    This afternoon I persuaded the eye hospital to reassess dad (whom they had discharged for the 2nd time although the consultant had said he was ready for the op) without him being referred through his GP for the third time! In the process of being firm but polite about all the problems I got to speak to a manager whose mother has Alzheimer's. This did the trick! She has made notes on his file, invited me to attend the assessment and reassured me that the doctors really do have plenty of experience of working with people with mental health problems.
    I'm also going to ask about the possibility/suitability of operating on him with a general anaesthetic.
    And for that matter I also enquired at a private hospital local to my parents and they were even more helpful. Mum didn't like the £2,600 price tag for each eye though!

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