How to convince my mum with mixed dementia that she should have her cataract operation?

[QueenB]

Hi, my name is Queenie and my mum has Alzheimers and vascular dementia. She is due a cataract operation but doesn't want it anymore.
She has had a few hospital stays since December. She first broke her hip and had an amazingly fast recovery. Unfortunately it was followed by another operation to drain some fluid from her knee. Then she fell again and broke her arm.
She doesn't want the cataract operation because she doesn't see the point of it even if I explained she could see better and it might make her happier as she is always very depressed and angry at times.
Should I follow her wish or should we just go ahead with the operation? She doesn't really comprehend the situation. I don't know what to do.
Has anyone been in this situation before?
Thanks.

 

[Grannie G]

Welcome @QueenB

Do you know if your mother would have a local or general anaesthetic for her cataract operation?

A local anaesthetic would require her ability to keep her eye still during the surgery. Do the doctors think she will be able to do this?

A general anaesthetic could have a marked effect on her dementia.

It really depends on the medical advice she has received and if her sight at present is not too debilitating.

 

[Lawson58]

I have been wondering how old she is and if apart from her falls and dementia, is she in generally good health?

I had my cataracts done and the result has been great. I had general anaesthetic for both but the procedure doesn’t take long so it was a very light anaesthetic. One of the biggest problems is that don’t usually do them at the same time so your mum might have to have two surgeries. It is not a painful procedure but she will need drops for a while after.

Is there anything she likes on TV that might give her a motive to get them done? Or does she like to colour in? I personally think it is a good idea.

 

[Sarasa]

@QueenB , welcome to Dementia Support Forum.
My mum had cataract surgery when in the relatively early stages of dementia. The main effect was that she went out and brought more make up as she thought she looked so old , she was in her late eighties at the time. Mum was capable of doing day to day care at the time, including the aftercare needed.
I’ve also had both eyes done and it was amazing the difference it made, specially as I rely on my sight as I’m severely deaf.
However apart from the anaesthetic problem would your mum remember to put eye drops in regularly after the op, which is critical to making sure there are no problems, or would there be someone there to help her and would she understand why they were doing it as the eye drops sting a bit.
I’m not sure that it would make her any happier. People with dementia are often not happy because they know something is wrong, but are not sure what, so blame random things like where they live or the people they see.
Your mum has been through a lot lately, maybe leave it a month or two and then see how she feels about it all.

 

[backin]

With my mum, for the second op we had a best interest meeting.
I'm not sure at that stage it made a great deal of difference to her.

 

[QueenB]

Welcome @QueenB

Do you know if your mother would have a local or general anaesthetic for her cataract operation?

A local anaesthetic would require her ability to keep her eye still during the surgery. Do the doctors think she will be able to do this?

A general anaesthetic could have a marked effect on her dementia.

It really depends on the medical advice she has received and if her sight at present is not too debilitating.

We have discussed a general anesthetic with the hospital as I didn't think she would be able to have it done without it. We're having an assessment about the general anesthetic this week. She already had two of them since the end of December for her hip operation then not long after a knee fluid removal.

 

[QueenB]

With my mum, for the second op we had a best interest meeting.
I'm not sure at that stage it made a great deal of difference to her.

Was the best interest meeting with the doctors and did your mum go for the operation?

 

[QueenB]

@QueenB , welcome to Dementia Support Forum.
My mum had cataract surgery when in the relatively early stages of dementia. The main effect was that she went out and brought more make up as she thought she looked so old , she was in her late eighties at the time. Mum was capable of doing day to day care at the time, including the aftercare needed.
I’ve also had both eyes done and it was amazing the difference it made, specially as I rely on my sight as I’m severely deaf.
However apart from the anaesthetic problem would your mum remember to put eye drops in regularly after the op, which is critical to making sure there are no problems, or would there be someone there to help her and would she understand why they were doing it as the eye drops sting a bit.
I’m not sure that it would make her any happier. People with dementia are often not happy because they know something is wrong, but are not sure what, so blame random things like where they live or the people they see.
Your mum has been through a lot lately, maybe leave it a month or two and then see how she feels about it all.

This is what worries me. In my head, I'd like to think she would be happier because she is nearly blind from one eye because the cataract is so bad. So seeing better should make her happier. But as you said so rightly, she is just not happy at all, at any point really. It's very sad. Nothing seems to give her any pleasure anymore.
So maybe you're right and we should just leave it. She is In a carehome and she would be looked after post-op. But the problem is that she thinks that all this care that she gets from the home or the hospital is torture and that people just want to hurt her. She doesn't believe it's for her own good.

 

[QueenB]

I have been wondering how old she is and if apart from her falls and dementia, is she in generally good health?

I had my cataracts done and the result has been great. I had general anaesthetic for both but the procedure doesn’t take long so it was a very light anaesthetic. One of the biggest problems is that don’t usually do them at the same time so your mum might have to have two surgeries. It is not a painful procedure but she will need drops for a while after.

Is there anything she likes on TV that might give her a motive to get them done? Or does she like to colour in? I personally think it is a good idea.

She will be 85 this year. She was generally well until lately, the falls and the 3 stays in hospital. It went a bit downhill after that. She lost a lot of strength because she wasn't moving enough and she hardly eats. Her dementia has got worse faster too.
Unfortunately she is not interested in anything anymore so she wouldn't watch TV more, or read more etc. She is very unhappy and is just waiting to go. Her own words sadly. That's why she's saying she doesn't see the point of the operation anymore.

 

[backin]

Was the best interest meeting with the doctors and did your mum go for the operation?

Yes it was with the doctor. Neither of us was really sure if it would help her vision but in the end because I hoped it might reduce the falls we went for it.
It meant I had to stay with mum for the pre op injections , which I didn't like (squeamish). Also I had to stay with her for the eye drops for several days which wasn't easy.

In the end not sure it made any difference to her.

 

[AlexB70]

My Mum also needed cataract surgery - the consultant advised they often didn't do cataract surgery on patients with dementia as aftercare could be problematic. Mum presented well whilst at the consultation, she had the surgery, but within 5 minutes of being home she was rubbing at her eye with a tissue and got so angry when we asked her to stop. Ultimately because of other issues (macular degeneration) it made no difference to her sight, but was a challenge for some time and caused a lot of upset for us all. I'm not sure this helps at all but she found it impossible to leave the eye alone, post surgery, so this should be a consideration.

 

[GeorgieW]

is there room in this boat for another one

I have the same issues. My mother needs the cataract op, but she didn't want it when it was first mentioned, but because she does not have capacity to remember not to rub her eye, or remember why she would be in hospital, I have opted for leaving it.

My Mum also needed cataract surgery - the consultant advised they often didn't do cataract surgery on patients with dementia as aftercare could be problematic. Mum presented well whilst at the consultation, she had the surgery, but within 5 minutes of being home she was rubbing at her eye with a tissue and got so angry when we asked her to stop. Ultimately because of other issues (macular degeneration) it made no difference to her sight, but was a challenge for some time and caused a lot of upset for us all. I'm not sure this helps at all but she found it impossible to leave the eye alone, post surgery, so this should be a consideration.

Knowing what a consultant has said, I now think I may have made the right decision - at least we wouldn't be wasting any ones time, especially has my mother is sooooooo good at "fronting"

 

[QueenB]

Yes it was with the doctor. Neither of us was really sure if it would help her vision but in the end because I hoped it might reduce the falls we went for it.
It meant I had to stay with mum for the pre op injections , which I didn't like (squeamish). Also I had to stay with her for the eye drops for several days which wasn't easy.

In the end not sure it made any difference to her.

Thank you very much for sharing your experience with me.

 

[AlexB70]

is there room in this boat for another one

I have the same issues. My mother needs the cataract op, but she didn't want it when it was first mentioned, but because she does not have capacity to remember not to rub her eye, or remember why she would be in hospital, I have opted for leaving it.



Knowing what a consultant has said, I now think I may have made the right decision - at least we wouldn't be wasting any ones time, especially has my mother is sooooooo good at "fronting"

The consultant actually said to my Mum, we don't usually recommend it, but you are absolutely fine.....she wasn't, but she also fronted soooo well....

 

[Bod]

Whem MiL (PWD) had hers done, the biggest problem we had, was persuading her that she didn't need her glasses!

Bod

 

[Frozen1234]

My dad age 81 who has vascular dementia had a cataract op last October under general anaesthetic. The consultant told me that, to see, you need good eyes but you also need your brain to process the visual info from the eye. (Or something along those lines!) We were warned that it may not make a difference. Dad is very mobile and walks everywhere but is cognitively fairly confused. I was very unsure it was a good idea but couldn't face the thought of him going blind and being even more confused, particularly as he walks in the countryside a lot.. So he had it...The op went all fine though the aftercare was a pain. But I think that the anaesthetic made his dementia a bit worse( I may be imagining it) but the eyesight is no better and I think his brain can't process it...so in hindsight we would not have done it. Just another example. As a family we found it a very hard decision to make...

 

[TessB]

I have read this thread with interest as my 95 year old mum has cataracts in both eyes. Sometimes she says she can't read the subtitles on TV (she has hearing aids), but other times she reads the subtitles out loud. So I'm thinking it's a processing problem as to whether she can/can't read subtitles at any given moment. Mum also has glasses which she often doesn't wear as she says she can see ok. I'd suggested a few years ago that mum have a cataract operation but the waiting list was around 7 months and mum didn't seem particularly bothered. I have felt guilty at not pursuing it, thinking it might give her a better quality of life, but after reading this thread, I don't think the operation would benefit her. Thank you everyone for posting your experiences and information.

 

[ChaceSoto]

In my opinion, it's a good idea to talk to her doctors and maybe a specialist who knows a lot about older adults or dementia. They can explain the pros and cons of the surgery for her and help figure out if she can make a decision about it. They can also give you some advice on what to do next.

 

[Crownlyn]

I am so glad I found this thread as I am also in the same situation. Mum needs the op in one eye and initially they wanted to do it under GA but I know that would scare my mum and she has heart failure so we were considering LA and was due an appointment with the anaesthetist last week but due to a UTI and hospital stay I cancelled the appointment.
This thread has made me rethink and not to proceed with the operation. Thank you.

 

[Richard T]

Has the option of local anaesthetic with sedation been considered? My mum had both cataracts done this way. With sedation the patient remains conscious (unless they doze off!) and is more relaxed than with local anaesthetic alone. Mum had sedation because she has a tremor and is prone to shaking if she tries too hard to remain still.
It was a bit tricky deciding when it came to the second op, because by then Mum's dementia had advanced to the point where they might've had to give her a general anaesthetic once they got her into surgery if she couldn't lie still. In the end she didn't need a GA and the operation appears successful.