As POA for my dad, I have a huge decision: Surgery or pain management?

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As POA for my dad, I have a huge decision: Surgery or pain management?

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My dad is 85 years old living in a long-term care home. He has severe dementia, AFib, COPD, his kidneys do not function at 100%, and skin cancer. Now I just found out he has aneurysms in both legs. Doing a CT scan means injecting a dye that could lessen his kidney function. Doing surgery to remove the aneurysms is risky for his heart, COPD and dementia. Doing nothing risks the aneurysms rupturing causing heart failure or amputation.

Alzheimer's & Dementia Care Decisions Palliative Care Senior Health

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Chergal: I am so sorry for the loss of your father. Deepest condolences to you.

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So sorry for your loss.

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Chergal, my condolences over the loss of your dear father. I'm so happy to hear that he was kept pain free & comfortable throughout his end of life journey. Sending you a hug and a prayer for peace.

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Every action has a consequence, for an 85 year old person, everyday presents risks. Please find out if he qualifies for Hospice as they can offer the care you can't.

As for you, please consult a psychiatrist (who can prescribe) who can help you let go..............it's the hardest choice to make, but he/she can help you deal with the 5 stages of grief. https://grief.com/the-five-stages-of-grief/

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Her parent passed.

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Cherbal, I am so sorry for your loss.

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On June 26, 2022 my father passed. At the end, they kept him painfree with medications. Thank you all for your support and concern.

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I am sorry and very glad he was pain free

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I wish OP would come back and tell us what the decision was. Hopefully, not to operate.

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Hospice & palliative care. My dad doesn't want to go to hospital , everytime he has had an ambulance out he refuses. He wants to stay comfy & be at home.
Hospitals just rush & you are a number on the system. Hospice treats people better at end of life & really home in with your dad's wishes. All the best & sending a hug

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I can’t make this decision for you but I will give you my experience. My Dad had kidney dysfunction, severe COPD and two aneurism's. He had an aortic aneurism and one in his spleen. He also had issues with his heart.

my Dad was in assisted living with my Mom and I was the POA and live near just my Mom now. Dad was going in and out of the hospital and in his mid 90’s we knew no drastic measures would be physically tolerated. He did not have dementia and he personally did not want intervention because he would suffer.

he eventually went on Palliative Care and his last 6 or son months were spent on Hospice. I personally pushed for that after his last hospitalization. He needed to be treated with IV Diuretics. It his his kidneys hard. He had to stay an extra 24 hours because his kidney function had dropped. He ended up going home and eventually ended up with oxygen. During the follow up by video with the cardiologist he told me that we needed to treat Dad conservatively with meds as he could not tolerate the only treatment he could receive which was the diuretics.

I truly understand where you are at right now because it gives you such a feeling of guilt but we have to do what we know in our heads and heart what we know is best for the one we care for. My Dad passed peacefully in his room where he wanted to pass and that gives me some measure of comfort.

I hope you have a caring team of health care providers who can help guide you in the right direction. Hugs to you, it is a tough place to be but you will do the right thing

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If I were in your shoes I would choose palliative / hospice care to make him more comfortable. His body is shutting down and his mind is already gone. No need to prolong his suffering. Make him comfortable. End of life decisions are hard and we pray for you to have strength and comfort while making these decisions for your dad.

Take care.

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Seems the better option is palliative care - keeping him comfortable and everything working as best it can - without trying to fix the aneurysms. If his blood pressure stays stable, the aneurysms are less of a problem than his COPD, AFib, or kidney disease.

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My cousin was the medical power of attorney for my mom, and my mom had the same situation. She was 81 years old. He asked me what should he do? Same dilemma. I told him since she couldn't speak for herself, then whatever decision he makes will be the right one. Dangers if you do and dangers if you don't. Therefore, just make the decision if you have to do it on your own and realize that there will be NO reason to feel guilt if your loved one dies. Death can occur whether you do or whether you don't.

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HI, I'm a caregiver but also a nurse. You need to weigh the pros and cons in this situation. It is not wrong to say no to surgery or testing if the benefits do not out weigh the risks. I often see elderly patients who are going through tests or surgical procedures and for what? Can this proposed testing and surgery have the benefit of prolonging his life, or improve the quality of his life? Probably not given all his other health issues and that should be your guide. Your father should be in peace and there is nothing wrong to say no and allow acceptance of how life will progress eventually to death. Most importantly is to cherish the time you both have now. Too often our desire to do everything possible actually hastens the death process, and the patient who has dementia suffers because of loss of routine in an unfamiliar place, eg hospital. I wish you luck in whatever decision you make.

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Chergal: You must trust the science of medical professionals on this matter.
Disclaimer - I am not a medical professional nor do I profess to be able to advise you on such matters in regard to your father's health.

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My vote is for hospice 100%. Dementia ruins any and all quality of life for most elders in the first place, not to mention the rest of your dad's issues. COPD is another life draining illness too. Combined with the others, give him comfort care and let nature take its course.

God bless and help you along this difficult road.

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I haven't read the many responses, just putting in my vote for not doing anything and maybe considering hospice. May you receive peace in your heart that you are making the best decision for him considering the circumstances.

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So sorry about your dad. If course his age and physical condition puts him at risk for surgery, None of those health conditions you mentioned taken alone are reasons to not have surgery. Kidney function declines with age for everyone. A nephrologist could possibly give insight into the risk of using a dye, but amputation of both legs is surely a greater risk for postoperative complications and death. Can the vessels with the aneurysms be minimally surgically treated? The anesthetic alone stresses the body of someone with frailty and compromised health. The acute problem is only one of many problems that contribute to risk and outcome. Sometimes the surgery is a success, but the patient dies anyway due to complications. His quality of life in his final days/weeks will not be improved. I would choose palliative care.

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Some very good insights in these posts. I just wanted to add that I work in cardiac OR and see both reasonable and unreasonable decisions about surgery made frequently. We have more medical modalities available to us all the time. Just because we CAN do something, does it mean that we always SHOULD? Often western medicine is inclined to have us medicate and repair without looking at the patient as a whole. It can become difficult for patients and family to navigate the decision process since there are often doctors wanting to move forward with treatment or surgery.
My 92 yo, demented father had cardiac valvular stenosis. The opportunity to perform a less invasive valve replacement was suggested. We chose not to do the procedure. He ended up declining, due to his dementia, fairly rapidly last year and passed away under hospice care. If he had received surgery, his limited time left would have been consumed by recovery in a rehab facility. Instead, he was able to be at home until the end.
Listen to that little voice in side your head. Mine hasn't lead me wrong.

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exactly. OP, don’t do it. hug!

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Dementia is kind of the deal breaker here. I went through similar a year ago. I really wouldn't consign anyone to dementia one second longer than they had to have it. It is a terminal disease and the end stage is as ugly as anything you've seen with any other disease. It is a disease without mercy. If I could do it over again, I'd spare my Mom that procedure and let nature take its course. Now, in retrospect, it was cruel to do that to her. It goes against every instinct you have to not "fix" something with a surgery or procedure but there's a lot to weigh and dementia is a big component in the overall picture.

Peace to you and whatever you decide.

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OMG. First of all my prayers are with you on this decision. Sometimes it is painful to be the POA. This is a very individual decision and neither wrong. If it were my dad with advanced dementia ,COPD( which is extremely difficult with anesthesia and sometimes difficult to get off a ventilator after surgery),atrial fib ( if he is on blood thinner ,they may have to stop before surgery to prevent excessive surgery)and his age being high risk for surgery I would say no to surgery and give him pain management and comfort care.This surgery will not improve his overall level of living and that is why , with love,I would do pain management.It is difficult to loose your dad but loosing him with dignity shows love. God bless you in keep you strong in this storm.Trish

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End of life is a tough decision for the caretakers,
Wife and I were in the eighties, both had knees problems
I had hip replaced, found out wife had dementia, we moved into an assisted living place, wife did not like but we had to,
she always wanted to go home but where she grew up as a youngster, she remembered past times but not what she ate that morning, scheduled a knee operation before the move but she cancelled the day before,
On driving before we moved she missed a turn two times, she got home and refused to drive anymore, I mentioned that she should keep up the driving she said if needed she could do,
was in pain and some time she asked if it was ok to wish to die, once I told it was ok, she got more relaxed, after a few months she was under care of hospice care then after we assured that it was ok to wish to die, she stopped eating, hospice people were very caring, did a wonderful job, She passed away in the morning while our daughter was singing Do Not Be Afraid, and I was holding her hand, they said that the sense of hearing is the last thing we loose.
We were married 62 years, she was a good mother to our four children and a very good wife, I do mis her very much,
after I said it was ok to wish to die she got more peacefull, I hope to be able to see her soon.

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Thank you for sharing. Peace be to you.

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This a very difficult decision I realize. Do you have durable poa and is there a living will? Luckily my dad had both in place. Especially his living will. He was in and out of the hospital in 2021 at least 5 times from having tia. The last one he had at the nh in rehab. The next day my sister emailed the social worker about them having the poa and living will. We assumed from the times before when he had been there that they had this on file because we had given it to them but they didn’t. So she faxed it again. Anyhow the social worker said that they needed her to sign a dnr because if they would find him not breathing or no pulse they would have to begin cpr and that would continue until the paramedics got there in which at that point they would take over the cpr and if when he got to the hospital and he was still unresponsive they would put him on life support and his living indicates that he would not want this. He had a really big soar on the back of his leg it got down to the bone because he had his poa and living will they could only keep him comfortable as much as possible. They could never find out why he kept having tia and even if they had surgery would not have been a good option because he probably wouldn’t make it plus all the legal stuff he had in place. He also had developed dementia afraid his fall in March 2021 in which he got 2 brain bleeds. It truly wasn’t that bad until about the end of August when he was in nh in rehab. At the first of August we had to make the decision to put him in long term care. On September 20 he went on hospice and moved to ltc. On hospice they won’t do anything that would be considered life sustaining they will only make them comfortable which meant no more drawing blood except to ck his potassium. I was glad because I know having the blood drawn was painful and his arms were so black and blue. His kidneys had started shutting down in August so they took him off his atorvastatin and hydrochlorothiazide. I would ck and see if he doesn’t qualify for hospice. This doesn’t necessarily mean he is totally at the end. It means given his problems the doctors feel like he only has six months left, it doesn’t matter if he lives longer he can still stay on hospice. I’m no expert but it sounds like he is ready for hospice. I’m surprised his social worker hasn’t talked to you about it. I know people think it means the end but it really was a relief and very helpful because they took over all his care and you only had those people to talk to and got response pretty quickly without having to try and track down all his care takers. I know it is a very hard decision but the most important question you need to ask yourself is is this the kinda life he would want to live. Please don’t take this wrong but in my opinion I would not do anything. Just make sure he is comfortable. I wish you the best in whatever decision you make. May god bless you in whatever you decide.

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It can always be a tough decision. You need to have this discussion long before anyone gets sick. There are advanced medical directives and power of attorneys that can put your wishes in writing. Everyone will be different as to how they want to end their life. So no advice here. But always consider what humane really is

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Chergal,
You're asking for an opinion on what is a heart-breaking decision. Here is mine.
At your father's time of life and with all of his serious health problems, he shouldn't have to be put through more tests and procedures.
Is he in pain? I think the goal now should be quality of life not prolonging his misery.
You say he has severe dementia along with all his other health problems, is elderly and lives in a care facility. He has no quality of life. Putting him through tests and procedures is not going to improve his life and health. It may even make it worse.
Let him pass into God's mercy. This is what I think is best.

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Chergal, Your question was close to home for me. I was POA for my dad who had COPD, AFib, and Dementia. He was the about same age as yours when I took him to the ER with confusion and blood in his urine. He had a UTI but during tests, they found a small spot that could be benign or cancer. A urologist came and sat on the edge of Dad's bed telling him they'd make an appointment in his office for a scope, then if surgery is required and the rest you know. Dad didn't even realize he was in a hospital so I checked that doctor and his bedside manner off my list. I discussed at length with Dad's Primary and we agreed that the testing would cause difficulties for Dad and I would not put him through surgery at that point. My dad lived another year and a half without new health issues, other than the expected UTI on ocassion and progression of Dementia. He died just before he was ready for memory care. I've never regretted the decision I made. Best to you and your dad.

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Tough decisions! I know my parents both wanted quality of life versus quantity of life. He has lived a long life, but has many health challenges. Not sure surgery would improve his life quality. Lots to consider!

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Chergal, Honestly, I'd take this "step wise". Do the CT with contrast agent and see the extent and severity of aneurism(s). Yes, there is some risk of worsening renal function, but then you'll have a better idea (and so will his physicians) about the need for surgery. All of these medical decisions are a risk:benefit analysis and not a right or wrong decision... Wishing you luck...

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Your only questions are will it improve his quality or life or create more difficulty?

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Put yourself in his place. What would you want? IMO I would think pain management would be the best decision. If it were my father, who also has severe dementia, I would manage the pain and let nature take it’s course. I feel I’ve already lost him twice, once when the disease took his memory and again when he had to go into memory care. He needs peace.

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Chergal, as you know, this operation will not increase function or quality of life. This is strictly about quantity, with not a passing mention to what dads quality of life is now.

You take him out of the nh, that means taking him away from his surroundings and any staff or residents he has bonded to. Should he be in hospital for even a week and a half, he could forget all about them, reintroducing the usually negative period elders have in entering a nh in the first place. That is if the nah doesn’t just make his bed available for the next patient.

So, ok, he is living, but now comes an adjustment period that may be worse as his dementia has progressed. If he has any quality of life where he is, best to keep him where he is.

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You are so right about moving him to another facility. He would be so confused that he would start to get agitated. And that would not be helpful to his situation at all. As it is now, sometimes he can not find his way back to his room.

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As POA for my dad, I have a huge decision: Surgery or pain management?

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