General anaesthetic - Age 90

[Feelingfree]

My DM has been diagnosed with gallstones and is in constant pain. Doctors will not remove gallbladder due to her age and risk with anaesthetic. She has reduced fat in her diet but still experiences regular pain, especially at night.

She is physically fit and healthy (walked 2 miles per day before).

I am going to her next hospital appointment with her as she wants to insist on surgery, despite the risks. She would rather take the risk than live with constant pain and be virtually housebound.

Any advice would be welcome. thank you

It's a little bit lazy to say that all the risk is in the anaesthetic (if that's what they really said)! We do do operations on nonogenarians where there aren't other options and they understand the balance of risk and benefit, but actually the surgical insult for a gallbag is potentially quite challenging for someone in this age group.

What people also seem to take home from the message that 'the anaesthetic is too high risk' is that there's a risk of death and actually it's a bit more complicated than that - intraop/immediately post-op deaths aren't that common generally, but a functional deterioration (eg cognitive decline, needing becoming more dependent on carers, needing to move to a care home) is quite a lot more common. If the surgeon's exhausted conservative options (including decent pain relief), then it may be worth referring to an anaesthetic pre-op clinic to discuss the pros & cons in the context of her baseline physiology (kidney/heart/brain function) with an anaesthetic consultant. HTH

Having had agonising pain with gallstones I can well understand why your mother doesn't want to live with it and would rather risk removal.

As PP said it is complicated with an elderly person, but IMO quality of life is the most important consideration.

I hope all goes as well as possible for your DM

Thank you @Greybeardy that's really useful information and food for thought. I will be sure to ask the doctor about a potential pre op assessment, depending on the discussions we have.

@Shiveringinthecountry , Yes quality of life is the most important thing for my mum

One of the problems with surgery for the very elderly is that the whole insult to the system, including the anaesthetic, can prove too much. Most people in their 90s have an underlying deterioration of most bodily systems and have little in reserve to recover with. It is not unusual for delirium to appear post-op, and this can prove persistent. It is impossible to predict how each individual might react. But erring on the side of caution is understandable.

However I have enormous sympathy with her pain - I have had gall stones.

I don’t wish to scare you but my mum had a simple knee op four years she was 83 she went into hospital fine and other wise healthy

after the op she was delirious , Was treated for pneumonia but never regained her faculties & later ended up in a care home 24 hour care .

@Feelingfree , has she tried Buscopan?

I think if I could have my time over with my mother again I would do every possible avenue before using general. Is there nothing they can do for her under local?

@Mischance this is my worry, the nurse I spoke to said similar. I’ve also had gallstones and had my gallbladder removed. The pain was really bad and I can’t imagine living with it. I’m hoping the doctor we are seeing next week has some alternative plans.

@Duchess87 Sorry to hear about your mum. It’s such a worry.

@Lovepeaceunderstanding she has liquid morphine for the bad attacks. I’m not sure buscopan would be strong enough but thanks for suggestion.

@Diamondglintsonsnow She has an appointment next week. I’m hoping we can discuss any alternatives rather than general.

It really helps hearing everyone’s experiences, I can discuss these with my mum. I not sure she fully understands what could happen. She thinks if she survives the operation then she’ll be back to normal, which she might, but she needs to understand the possible complications

Hi OP,

It's such a difficult situation.

I'm posting this simply because you've said that it helps to hear about experiences. My elderly aunt fell and broke her shoulder, and had to have a general anaesthetic. She was in her 80s. She unfortunately developed delirium, and the mild confusion she'd been experiencing before the operation became a lot more severe. She went home for a while, where we looked after her, but she deteriorated and had to go into a home. She wasn't ever 'herself' again.

Does the morphine help? If so, would taking the morphine regularly be an alternative to a general?

@Shiveringinthecountry This is the story I am hearing from a few people now about deterioration after the op. Yes the morphine does help. My brother, who lives with her, said she has improved since reducing fat in her diet. When I see the Dr next week I will ask about either changing or increasing the pain relief.

This thread has helped me get a wider perspective on the difficulties she could face. I now need to explain this to her so we can go to the appointment prepared, as much as we can be.

My dm had a GA aged 91

They did a thorough pre op assessment and were very clear about the risks for a lady of her age, eg the risk of pneumonia following surgery in the very elderly was not something that we were aware of. In some cases it can be painful following surgery to cough and failure to cough and clear your lungs can increase the risk.

What we were not prepared for was the need for a list of everything medical issue she ever had - Quite a long list for a woman of her age, am sure we forgot some things.

These were then reviewed to ensure they had as complete a medical history as possible - in order to gauge the risk of proceeding.

My dm went ahead and made a remarkable recovery, her underlying health was pretty good though.

@FriedSprout I'm glad your DM had a successful outcome, it's nice to hear a positive story. Whilst my DM is physically strong, she is very forgetful now. This is my concern, if this becomes worse.