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Mom is almost 95 years old. I notice that she is becoming confused and hallucinating sometimes. I know cataract surgery would improve her eyesight but if the local anesthesia causes her to become even more confused, I'm not willing to risk that result. Shes says she sees okay and my sister says she seems to see alright. Has anyone out there had the same dilemma? What did you do?

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Keilin...
My mom is the same age, and we decided together to get her cataract surgery.
It went well....the first eye was her "good" eye, which left her 100% blind until we could remover her bandage the next day. That was the worst of it.
Also, many eye drops must be applied over 3-4 weeks....takes determination and patience to get thru the rounds of eye drops.
She's all done now....zero problems, thank God.
If you can discuss this procedure with your mom, and she can understand what to expect...it will go pretty well. But, she must Understand and be receptive to having it done.
Hope this helps.
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Hi Keilin, I had to have both eyes done recently in my early 40's! Mine were pretty bad, had grown slowly over so much time it had gotten to where I plain saw everything as though looking through waxed paper. My eye Doc was shocked when he dilated and found they were like that. My improvement was remarkable, it reminded me of being grade school aged, so suspect that was when they started growing. I've told anyone considering it, yes, go get it done. :-) But if they aren't that bad, and given the age, here's things my experience would have me consider. I was put clear out. And I was thankful for that. The 1st eye went smoothly. Not much affect from anesthesia. The many drops that have to be put in days before and days after have to be held in the eye for like 5 minutes each type, seems like there were 3 types, and 3 times a day each. Was told it was very important to prevent infections, inflammation. So someone would need to sit with her several times a day and make sure that went off OK. Afterwards I was told not to get any tap water in the eye for 7 days which makes washing face and hair a bit awkward and kind of scary. (Was told organisms in water normally not harmful could cause problems with the operated eye.) Sleeping for 7 days was a bit of a trick. Was given a protective hard lens to tape over the eye for sleeping to protect it, other wise a person could very easily rub it while asleep, it since it hurts a little, feels weird. So if she naps too, someone needs to make sure the cover is on. Leaning forward is a "no no" for 5 days, (think standing on your head, pressure). :-) So pretty much would plan on having someone with her for the 7 days afterwards. Now, the second surgery, while still awake the eye becomes completely numb, they tape your hands back so you don't mess with the eye, or put a little piece of tape over they eye to remind you not to rub it. The tape that was put over my eye was loose and scratched the cornea pre op, and since it was numb I couldn't tell it was happening. The pain from the scratch was really, really, terrible. I woke up in the middle of the night the 1st night with water absolutely pouring out of the eye since the medicines had worn off. Had to get the Doc out of bed. It was frightening. It required lots and lots of follow up trips to look at the scratch, check it's healing progress, make sure it wasn't infected. Had a bad reaction to the anesthesia the second time, also. Had chills and shakes and nausea and memory loss for a day or 2. Would I do it again? Yes, I see so much more clearly and it makes life so much easier. But things to consider for you. :-) Good luck!
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I would like to clarify that my Moms dementia is NOT severely advanced. She can follow directions and also I can leave her a home during the day. This entered into our decision making :)
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Thanks Cathy2014. I appreciate your perspective.

I think it most certainly does depend on what level the dementia is when you consider doing anything like surgery or some medical procedure that requires patient cooperation and compliance. For some, who's family members have moderate dementia, they may not be able to comprehend what it's like to be with a loved one who is severely effected. They may not comprehend how the loved one may tear off a bandage, pick at a wound, attempt to crawl over a bed rail, refuse to open the eye for drops, etc. Challenging behavior can make simple procedures very difficult. And then when the doctor doesn't get it either.......it's tough.
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I am an RN, and help getting people ready for cataract surgery often. If your mom is not cooperative to lay still as she would be some awake they could do general anesthesia. You can have a slight feeling of irritation and also you have to watch that she gets the eye drops and also does not rub her eye. Personally at age 95 I do not think I would put her through it. My husband is 61 with FTD dementia and would have to have general anesthesia. I will not put him through it. With him it would not help his quality of life any. It would not help to have good eyesight with his dementia getting so much worse. I have helped patients get ready for the cataract surgery that were mild dementia, it would benefit them the most. It is a hard decision.
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PS Be sure to go with the lenses that Medicare pays for. They worked fabulous. Some offices (not all) try to upsell you to better lenses. NOT NEEDED! They also bring much more profit to the doctors, if you get my drift. A friend of mine who is a doctor shared this tip with me. He said to be just be aware.
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My 85 Mother has dementia and also needed cataract surgery for both eyes. I spoke with the Chief of Neurology at the best hospital in Southern CA. I also spoke with the top eye surgeon at UCLA. Mom claimed that she could see just fine but she was used to diminished vision. Both Doctors said that it would not impact her cognition. There is ample medical journals with studies that state folks with dementia will cope better when hearing and vision issues are addressed. She is on a very complex medication regime as she also get seizures etc. She did beautifully with the surgery. I was thrilled as we are trying to reduce her fall risk. Best of all she was shocked at how much better she could see. Our family was THRILLED because the television appeared much brighter to her. This is great as TV is something she watches. I took some days off to make sure that the eye drops were put in at the proper time and that the after care was excellent. It was a breeze. I, too, am HIGHLY sensitive to adding medications or anesthesia. If her health is decent and you think she will live a few more years, I would do it. She will enjoy the beautiful new colors the operation will bring her. Oh and we had them do the eyes a few of days apart rather than a few weeks so her balance would not be impacted. The doctor agreed!
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Guess I am stuck with mine. The eye Dr told me she did not want to do it because of the operative risk. The head of anesthesiology he would never give me an anesthetic. Not really sorry as I am terrified of having the proceedure even though being reassured that there is nothing to it. I am still legal to drive but close vision is very poor. Now I have to see the ear Dr - not afraid of her!!!!!!
Gone from being relatively healthy three years ago to being very "old" now.
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I have worked as an Ophthalmologist assistant before. They give a medicine to make you sleepy but not general anesthetic. then only numb the eye.Most patients tolerate the procedure well.My only concern would be how advanced the dementia is and would the outcome be worth the surgery.
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I had cataract surgery in both eyes (about a year apart) in my late 60's, and it was simple and painless, local anesthesia. The only other thing was the patch for 1 day and drops for a few days. I did ask about the prescription in the implants, and having been nearsighted all my life and most of what I do is fairly close, I got close-vision implants. Each side is slightly different, which extends the total range. I have progressive lens glasses with a driving prescription on top and clear on the bottom, and rarely wear them in the house. People are surprised when they find that I can read very small print, so I tell them "I cheated!". If your mom is a reasonably calm person, I think she'd do fine, and eliminating the glare from lights at night was a definite improvement. If she can still read and enjoys looking at pictures or TV, improving her near vision would be a plus.
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My dad went through the the same last month and he all is ok; all his doctors OK'd even though everyone was saying it should be fine...because it's routine nowadays (he has Parkinson's along with the hallucinations and confusion)...my peace of mind came through the Drs clearance. Am hoping that with the better vision, it can help with the hallucinations as well
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From what I understand this only happens under general anesthesia, which is a heavier anesthesia and would not have to worry about something light like what they use for cataract surgery. My mother has some dementia and it did not affect her at all. You only need to worry about the heavy anesthetics.
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FWIW I'd like to add a few comments on this. I had a detached retina about 9 years ago (at age 55), and the various surgeries and procedures failed to restore most of my vision, and the little I had eventually disappeared, too. Because of all the manipulation with my eye, I developed a cataract which, I understand, always happens (I don't have one in my other eye, and neither of my parents ever needed cataract surgery). I only agreed to the surgery because the ophthalmologist said it was impossible to examine my eye due to the opaque lens (which appeared golden-brown in the mirror). I drove to the clinic and had the surgery--they probably using numbing drops on the eye before it. I described it as looking as if someone were shoveling snow, and the surgeon said that was about what it was like. Afterward, I left the clinic and drove back to work. The staff said they wouldn't recommend this for most patients but they knew I was used to driving with one eye. I think the replacement lens is actually for distance, but of course it is irrelevant now.

I am very nearsighted (a risk factor for retinal detachment), and I gave up my contact lenses for glasses (with the one side being plain glass) to prevent risk of infection and also for physical protection of the good eye. I had a choice of being corrected to a very "crisp" 20/20 or just a "marginal" 20/20. I chose the latter because I'm still able to see things up fairly close while wearing the glasses, which I wouldn't be able to do with the crisp correction. However, I don't wear the glasses when reading or typing, or for many indoor activities at home. I'm mentioning this in case someone wants to keep the option of a "marginal" 20/20 in mind to be able to retain more close-up vision, which I suppose is a possibility with a replacement lens after cataract surgery as well as with eyeglasses.
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I have had both eyes done and so has my husband. We had to wear a patch until the next morning when we went for a follow-up exam. Would she be able to do that? In my first surgery I was partly out, could feel him working on my eye, it didn't hurt, just felt funny. The Doctor was very upset when he found out, he had an anesthetist he wasn't used to working with. The next time I was out totally for a few minutes then spent about an hour or two in recovery. The same was true for my husband, out for a little bit and an hour or two in recovery.
We had to keep a patch over the eye until the next morning when we saw the doctor and he examined it. If you don't think your mother is up to that, or would pick at the patch you might want to rethink surgery.
How bad is her cataract? I could see, just colors were like someone had been smoking in the room. I laugh because I had some white towels and white undies that I had been bleaching over and over because I just couldn't get them white. It was my eyes not the poor towels and undies. I couldn't see to drive as well at night. Things were a little bit blurred.
Also, I was given a choice of seeing close up or at a distance. I chose distance so I didn't have to wear glasses to drive. I need glasses for reading. I would recommend having close up lenses put in for your mother if you do have the surgery.
I hope this helps. What did the ophthalmologist say?
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Having had cataract surgery, do not worry about the anesthesia. It is primarily used to deaden the eye and just a little systemically so she will not move during surgery. Trust me, the doctor does not want any malpractice lawsuits. Seeing better will improve her life!
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A qualified anesthesiologist should assess elderly patients before any kind of anesthesia is performed. (My DIL is an anesthesiologist) If they feel the patient is not capable of handling the anesthesia, they can personally refuse to do the procedure. Unless it's a life saving situation, but still--they have the obligation to not perform anes. on a patient they deem unfit. I'm not saying another dr wouldn't do it, just, elderly patients are a different animal. My DIL assessed my mother before her hip surgery (she was not the doc in charge) and said "no way, no how, not in a million years would I do anesthesia on her".
Eye surgery is different--they rarely do it under a general. But if she's combative, she's going to need to be semi-sedated. It's a choice you'll have to make. Good luck!
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We endured a somewhat similar predicament a few years ago. Ophthalmologist suggested that Dad would benefit from cataract surgery and recommended a renowned facility in a nearby town. After obtaining a full medical history and extensive pre-op examinations and testing, we then set up a date for the procedure. We were informed that he would require sedation due to his inability to understand and follow simple instructions.
On the day of the procedure and as he was being prepped, we were ushered into the office of the Director of Nursing and informed that they would be unable to perform the surgery due to Dad's extensive list of medication sensitivities. We were then advised that he was not a good candidate for the surgery and to retrieve Dad ASAP and, if desired, make other arrangements.
Sadly, what we saw "behind the scenes" was an assembly line of elders being systematically sent along from point A to B to C etc. as quickly as possible leading us to believe that the main object was to get as many procedures completed as quickly as possible.
Subsequent discussions with Dad's PCP have reassured us that he is doing as well as any other 91 year old at this stage of his life without being subjected to this invasive procedure as long as we keep him Safe, Healthy and as Happy as possible.
As for Dad, although he does experience some visual blurring, he still can spot a bluebird on the sidewalk 50 feet away, can read the captioning on his favorite TV shows, and has no problem cleaning every last morsel of food off of his plate.
The bottom line here: Yes, while the cataract surgery might have improved Dad's eyesight, would this have positively impacted his quality of life and daily living or would having him undergo the procedure and whatever complications the anesthesia might have caused and any subsequent confusion caused by same have proven detrimental? In this case, probably not.
So, if you are experiencing concerns, be sure to engage your Mom's PCP in the discussion before making any decisions.
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Many people with dementia can still follow directions well enough to get through cataract surgery, with it's local anesthesia. Both of my parents had both fixed, and both had dementia. The biggest thing I see, would be they would need assistance of a family member to stay on top of all the eye drops needed at specific times for the recovery time. I do believe that having improved eyesight would keep the mentality working better for longer, as well as help keep elderly from falling too. Local anesthesia generally does not affect any of the dementias.
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Keilin My Mother had cateracts in both eyes and had LAZER TREATMENT which removed the cateracts. No anesthetic needed. I brought Mom to the Hospital on both days, as the Hospital would only do one eye at the time. It was perfect and Mom had perfect sight up until She passed away at 87 years of age.
As for putting Your own Mom through an anesthetic at 95 years. No I would not never, not at that age. Enjoy every day You have with Your Mom, and be thankful She's so wonderful. As for being a little confused and hallucinating " that's probably from the medications....sleeping tablets can cause that, as I had to STOP giving My own Mom sleeping tablets as they made Her confused and caused hallucinations.
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Actually getting through the procedure, following instructions, lying still, not touching her eye, etc. would be a great concern to me. I'd get a second opinion from another doctor and I would try to locate one who is familiar with patients who have dementia.

From my experience, many doctors do not really realize just how resistant and uncooperative a patient with dementia may be, due to no fault of their own. They don't seem to comprehend that the adult would be similar to operating on an infant with regard to the their ability to follow instructions.

You might ask questions like what if she moves when told not to. What if she touches her eye after the procedure, etc. Would restraints be required? It's a lot to consider.
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Unless it is an emergency (unlikely), I recommend, if you are considering moving forward with cataract surgery, that you first receive a second opinion from an independent, objective excellent Ophthalmologist. Fortunately, there are ethical medical professionals that will objectively consider a patient's age, cognitive status, medical status, surgical risks, postoperative care, etc., A good eye doctor will base their decision on patient best practices- benefit vs risks vs. receiving money for procedures (I am not suggesting that your mom's eye doctor's motivation was money). Unfortunately, I have met unethical medical professional that may not consider the patient first. As a medical professional, it is important to examine all the factors, for your mom's best possible outcome and quality of life. Ask the second opinion eye doctor, if you/your mom elected not to have cataract surgery, would this impact her quality of life and daily living? It is wonderful that you have followed your gut thus far, and have questioned the appropriateness of cataract surgery for your 95 year old mom. Your mother is very lucky to have you!
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If your mom is able to pick up a dork and glass and walk without bumping into walls then I would not succumb her to this or any surgery unless it is absolutely necessary. My father has dementia and any type of invasive procedure is very scary for them. Just enjoy your time with mom.
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I had cataract surgery when I was in my mid-60s, and I thought it was amazing! From being turned down for a driver's license, I went to where I didn't even need glasses for driving, just for reading. It is painless, but if your mom has dementia and can't understand what is going on, then you may have a problem.
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My mother's first cataract surgery did involve being put under since she had let it go so long, and it was more difficult, said the surgeon. She certainly needed to have it done. She was not under long and recovered fine physically, though that was my excuse for finally having her move in with me since she really could not look after herself well even before that point with Alzheimer's (she was in her late 70s then). For the second one done a year later, she was awake. She had IOL implants on both sides and wore glasses. She did fine but of course hallucinations have increased over time. At this point, her depth perception is lousy. We saw the surgeon yearly but were told last time since she could not even read the chart and no change was made to the eyeglasses that we did not have to return. She sometimes wears her glasses, but I feel they really don't help her much.
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Keilin have you consulted an ophthalmologist about your mother's eyesight? The reassuring thing is that if she doesn't actually have what they call a "ripe" cataract they wouldn't undertake surgery anyway. They also won't do it if she isn't able to follow their clear instructions during the procedure - because, as others have pointed out, the patient ha to be fully awake and participating.

I would be very surprised if the local anaesthetic had any effect on your mother's mental state; but the procedure itself is quite stressful though not painful, as described by people who have undergone it.

The bleared vision caused by cataracts could be exacerbating your mother's confusion and apparent hallucinations, on the other hand. If I were you I'd whisk her off to an ophthalmologist for professional advice on the risks and benefits.
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I had cataract surgery when I was in my 70s. I was only partially sedated and required to be alert, not move my head, not blink and to follow a moving blue light on a screen. To keep me on track following the blue light, the surgeon spoke to me brusquely. I am a sharp 85, but don't see myself opting for elective surgery from now on.
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As above, but you must make sure that the drops are put in regularly.
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Keilin, I can fully understand your concern, but it's my understanding that the patient will be awake during the surgery, that only the eye area is numbed.

The only thing is that your Mom might be scared about the surgery and that will put added stress on her. Check with her primary doctor to see if he/she could give her something to calm her down, if it is also ok with the eye doctor.
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