Worried about unnecessary operation

Jointly and severally means that only one of the attorneys needs to give permission/authorise/sign.
Is the operation that is being cancelled in the private system or NHS. Very unusual to cancel/postpone a private op. unless for health reasons

Odd that they disclosed it and odd that it was cancelled when DB only wanted a discussion.

NHS operations get cancelled all the time so it’s a moot point it was that or related to your brother’s call. I’d be surprised if anyone would have disclosed to your dad your brother’s as it would be against GDPR. Maybe he guessed.

A couple of thoughts re the medical side of the

People with dementia get all the same medical problems that people without dementia get but are at a massive disadvantage because either they can’t express themselves clearly or people just put it down to ‘the dementia’ and therefore not worth bothering about. While it isn’t always in a demented person’s best interest to have surgery, there are lots of operations we do for people with severe cognitive impairment that may improve their quality of life. The risk of proceeding with an operation has to be balanced against the risks of not proceeding for that individual, taking into account what they may have wanted for themselves if they still had capacity. It usually involves pretty robust multidisciplinary discussion and isn’t down to a single maverick surgeon to make a decision. Surgeons in the private are unlikely to make ‘bold’ decisions about operating on someone incredibly frail because there is usually such limited back-up if there are complications, and, for want of less blunt terms, they’re not going to want a demented ‘bed-blocker’ on the ward not making any money.

There is a risk of post-op cognitive deterioration with pretty much every operation (including in patients without dementia) - this isn’t as closely related to ‘the anaesthetic’ as people assume, but rather the whole package of perioperative disruption. However, chronic incontinence with skin break down, pain, UTIs etc also can cause cognitive deterioration, so it may well be that a quick procedure under GA that fixes a mechanical/physical problem could improve things longer term. Some procedures that can be done with just local in patients who are cognitively intact are done under GA on patients with dementia because it may be less stressful for them that way.

@parsniiips not sure if this is helpful to know or not, but it’s quite common for patients with dementia to deteriorate after a hip fracture - we almost expect it (even non-demented patients often take a step backwards after a fractured NOF), but the injury is so painful and so likely to result in death that we operate on almost everyone even if only to allow comfortable palliation. The 1year mortality after a hip fracture is still disappointingly high, partly reflecting that there’s often a significant medical problem underlying the fall that caused the fracture. Mortality’s around about 25% with surgery & 70% if surgery isn’t done, and not much has managed to improve that despite efforts.

They're fantastic.
Also dementia uk.

Your mother is ill though, so you tell the receptionist you have LPA and the appointment is for her.

Maybe a hip replacement did shorten her life, but perhaps it improved the quality of what she did have, by getting her out of pain.i think you need to butt out, your dad's her n of k, not you and presumably has poa too. Also the surgeons at the hospital will want to act in your mother's best interests too

Surgery is associated with increased risk of cognitive decline, called POCD - post operative cognitive decline. This is most common in people over the age of 60. It can last for a few weeks or months in younger patients, but in the elderly the decline can be long term and they don’t recover. Surgery in the elderly is also associated with systemic neuroinflammation which may be linked to the cognitive decline.

Have you been in touch with your local admiral nurse? They are a lovely team of specialists dementia nurses.
You can speak to them about your concerns and how you believe your lovely dad has carers burnout.
Your dad will need supporting , even if he doesn't realise or want to acknowledge yet, they can sometimes feel as if they have let their husband/wife down as they made the vow of in sickness and in health.
It's really difficult
Best wishes

MIL went back into a care home when FIL died. At home she needed frequent GP visits for various reasons, at least 2 a month, sometimes more. She's had 2 in the 5 months since she went back in and one of those was a medication review.

Care homes can seem grim to us because we wouldn’t want to be sat in a chair watching tv or in the day room playing simple games with the staff I can second that. My father now doesn’t get out of bed, sleeps a lot, gazes out of the window, and literally clock watches, predicting what number will come next. But he has a level of contentment that he has never before had in his life.

I understand your concern, an operation on an already vulnerable person can do more harm than good.

My grandma had a hip replacement age 83 while she had Alzheimer's (it was necessary after a fall completely shattered it) and she went downhill massively afterwards. She was never the same again and passed away much sooner than doctors expected.

We don't know why, but she was definitely significantly more affected by Alzheimer's immediately after the operation.

Another relative had a hysterectomy in the very early days of dementia and rapidly declined afterwards. It wasn't a necessary operation, she had a slight prolapse of the uterus and was given the choice of having a hysterectomy or seeing how she coped as it wasn't actually bothering her too much at that point. She was adamant she wants the operation so we supported her through it. She was living relatively independently with family popping in and out every day and went into a care home within weeks of having the operation.

It may have just been coincidence but we as a family felt like these operations were when things went drastically down hill.

OP look. Some posters on this thread don’t actually know what Alzheimer’s is like. The ones that do have made helpful posts but they are the ones warning you not to let your father proceed with an operation.

Bottom line is if your mother is at the stage that she is not recognising relatives and thinking she is going to prison she is in no fit state to have any kind of operation. Full stop.

The poster who knows someone who had “elective” surgery with Alzheimer’s appears not to understand it’s a spectrum and in the early stages only features mild cognitive impairment. People with Alzheimer’s can still have mental capacity to make decisions.

Based on your mother’s symptoms how likely is she to pass a test for capacity to make medical decisions?

Saying your mother is on the same page as your dad is meaningless, my father, for whom I’m a carer, simply agrees with whatever people tell him as he has no real idea what they are saying.

The incontinence is most likely caused by the dementia, in which case an operation will not make any difference. It will not in any way magically make your father able to care for your mother. I mentioned my aunt’s incontinence was not caused by dementia, but even so she was still advised not to have any invasive treatment.

You MUST look at the terms of the LPA for health and welfare. Does your father even have LPA? If not he has no legal right to make any decisions for her and if you let him and it goes wrong you will be at fault. If he does.- is it “jointly” or “severally”? If jointly then your father cannot make a decision without you and the other attorneys’ joint agreement. If “severally” your father can make a decision on his own but he would be very unwise to act against the wishes of any other attorneys.

As you have LPA I would ring your mother’s GP and tell them you are extremely concerned about your mother’s condition, her capacity, and your father’s capacity to care for and make decisions for her. (Even if you didn’t you could still discuss your concerns about her care).

The private hospital aspect is a concern because, as can be seen from cases of inappropriate plastic surgery, some private surgeons are happy to perform surgery as long as you pay them.

Even if this is an NHS decision and operation, that doesn’t mean it’s in your mum’s best interests. GPs are not consultant geriatrician or neurologists and if your mother’s Alzheimer’s was diagnosed some time ago, the GP may not be up to speed with exactly what stage her dementia is at.

You need to wise up and start using your LPA for your mother’s benefit. Sometimes care from a relative can be, however loving and well meaning, inappropriate. Your DF is totally out of his depth.

What your mum really needs at this point is not an operation but night-time carer.

I think her actual concern is she doesn't know what is going on and so doesn't know if it's a good idea or even if it'sjust something her dad is trying to make happen. My experience would suggest that, given the OP has POA, the only way to get any clarity is to have a chat with the GP. If you had heard some of the misunderstandings FIL had over his own treatment - the most notable being " I need a kidney scan and they are doing it at the GP surgery 9.30 tomorrow" when the GP actually said "I need to speak to your urologist about the best medication and whether he wants a scan so you can pick up a prescription for antibiotics after 9.30 tomorrow ". If I hadn't had a kidney scan myself so knew what was involved all manner of rejigging plans to get him there and look after MIL would have happened. It wasn't any form of cognitive impairment he just used to panic and just hear "blah blah scan blah blah 9.30 tomorrow blah blah at the surgery blah blah"

I think you are a little arrogant to think you know about the risks and benefits of surgery than the specialist doctors working at her local hospital. I very much doubt, given NHSvfinances that they would be recommending a needless operation.

This is totally spot in advice x

RN here.
I think that incontinence is part of dementia as pp said to do with the signals and not recognising the "need to go"
If I were in your situation, I would ring social services. I wonder if your dad could be suffering from carer exhaustion, and if he's not able to manage your mums incontinence, he will need help as things progress.