Determining which elderly patients to operate on for elective joint replacement surgery is an art. Age, for many, is but one limited variable. Many elderly patients are seeking to remain active, they are mentally sharp and have very few medical issues.
When non-surgical treatment fails, and their quality of life is poor, total joint replacement stands a good chance at restoring their ability to ambulate and giving them back their freedom to move and some degree of independence.
Many of our elderly joint replacement patients end up transitioning to a sub-acute rehabilitation facility — or a glorified nursing home during the convalescence phase of their recovery. Some patients will do very well … but I often start to notice a cognitive decline in many.
Was it the stress of surgery?
Did I evaluate them improperly when I indicated them for surgery?
Hmm… Let me look at their medication list …
Three very potent, mind altering psychoactive medications that can turn the most lucent soul into a nearly comatose mess.
During the acute phase of recovery some of these medications have a short term, limited role — but rarely in combination with one another. When the elderly are recovering from surgery, the fewer psychoactive medications they are on, the better the chance they will recover uneventfully.
The elderly are at very high risk on this TKO combination. They become lethargic, confused, they can fall, they will not want to eat, and may not want to participate in their rehabilitation to the full extent that they are capable of.
If you are a patient (and capable of staying alert long enough to read this), or if you are a caregiver and you notice that you or your loved one is more somnolent than usual, have much less energy, no appetite, and just seem to have lost their fight — then please speak with the nursing and physician team at the institution. Getting off most if not all of these medications is critically important in the road to recovery from major surgery.