Surgical Options for Dementia Patients with Prostate Issues: A Family's Dilemma

Regarding how to perform prostate surgery on elderly patients with dementia?

My grandfather is 74 years old and has dementia (he does not exhibit violent tendencies but has difficulty with verbal expression).
He recently underwent hernia surgery and currently has benign prostatic hyperplasia, for which he has a urinary catheter in place.
He has been expressing a strong urge to remove it, which has been very challenging for our family.
We understand that surgery is the only option with the highest chance of recovery, but there are no guarantees of success.
Previously, doctors at a hospital in Zhudong were unwilling to perform the surgery, possibly due to concerns about medical disputes, which has left us feeling disappointed with the medical professionals.
We have attempted to take him for surgery before, but he is very resistant to pre-operative examinations, and neither coaxing nor forceful methods have been effective in getting him to comply, let alone undergo surgery.
Ultimately, we had to return home, and not long after, he removed the catheter again.
We had no choice but to take him back to the hospital to have it reinserted, which has been a painful process.
I would like to inquire whether, given my grandfather's dementia, it is possible for us as family members to write a waiver to protect the doctors from liability in case of medical disputes, regardless of the outcome of the surgery.
Would this be a feasible option, or is there a way for family members to safeguard the doctors' responsibilities? Is it sufficient for the doctors to agree to perform the surgery under these conditions? Additionally, could you provide some methods to help my grandfather undergo examinations and surgery more calmly, or recommend doctors who have experience with similar cases and are willing to assist with the surgery? We live in Zhudong Township, Hsinchu County.

Xiao Kai, 20~29 year old female. Ask Date: 2007/11/26

Dr. Tu Xiuhong reply Urology

Difficulties in urination and urinary retention are not necessarily caused by benign prostatic hyperplasia; elderly individuals may experience urination difficulties due to brain lesions as well.
It is advisable to seek examination at a major hospital.
Dr.
Tu Hsiu-Hung.

Reply Date: 2007/11/26

More Info

Navigating the complexities of surgical options for elderly patients with dementia, particularly in the context of prostate issues, can be quite challenging for families. Your grandfather's situation, characterized by dementia and prostate enlargement, presents unique hurdles, especially when considering surgical intervention.
Firstly, it’s important to understand that dementia can significantly affect a patient's ability to comprehend medical procedures, follow instructions, and cooperate during examinations or surgeries. This can lead to increased anxiety and resistance, making it difficult for healthcare providers to proceed with necessary interventions. In your grandfather's case, his desire to remove the urinary catheter and his refusal to undergo further examinations highlight the challenges that dementia presents.

Regarding the surgical options for prostate issues, such as benign prostatic hyperplasia (BPH) or prostate cancer, surgery is often considered when conservative treatments fail or when the condition significantly impacts the patient's quality of life. However, the decision to proceed with surgery must weigh the potential benefits against the risks, especially in patients with cognitive impairments.
In your grandfather's case, the reluctance of doctors to perform surgery may stem from concerns about the risks associated with anesthesia and the potential for complications, particularly given his dementia. Additionally, the possibility of medical disputes may make healthcare providers hesitant to proceed without clear consent and understanding from the patient or family.

One potential avenue to explore is the concept of informed consent. While it is understandable that you may want to provide a waiver to protect the doctors from liability, it is crucial to recognize that informed consent must be based on the patient's understanding of the risks and benefits of the procedure. In cases of dementia, this can be complicated. Family members often have to step in to make decisions on behalf of the patient, but this must be done in a way that respects the patient's dignity and autonomy.

To facilitate a smoother process, consider the following strategies:
1. Consult a Geriatrician: A specialist in geriatrics can provide insights into managing your grandfather's medical issues while considering his cognitive status. They can also help coordinate care among various specialists.

2. Behavioral Strategies: Employing calming techniques and familiar environments may help reduce anxiety during medical appointments. Engaging a psychologist or psychiatrist who specializes in dementia care could provide strategies to help your grandfather cope with the stress of medical procedures.

3. Advanced Care Planning: Discuss with your family the possibility of creating an advanced care plan that outlines your grandfather's preferences for treatment. This can include discussions about his values and what he would want in terms of medical interventions.

4. Explore Alternative Treatments: If surgery is not feasible, consider discussing alternative treatments for prostate issues that may be less invasive. Medications or minimally invasive procedures might be options worth exploring.

5. Seek a Multidisciplinary Team: Look for healthcare facilities that have a multidisciplinary approach to treating elderly patients with complex needs. This team can include urologists, geriatricians, nurses, and social workers who can work together to create a comprehensive care plan.

6. Support Groups: Connecting with support groups for families dealing with dementia can provide emotional support and practical advice from others who have faced similar challenges.

Ultimately, the goal is to ensure that your grandfather receives the care he needs while minimizing distress and maximizing his quality of life. Open communication with healthcare providers about your concerns and your grandfather's condition is essential in navigating this difficult situation.

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