Guide to Complications After a Medical Treatment
ContentsReasons Seniors Have An Increased Risk Of Complications After Medical Treatment Anesthesia And Seniors Fall Risks After Surgery Infections After Surgery Blood Clots After Surgery After A Medical Complication Things You Can Do To Prepare For Complications After Medical Treatment Options For Long-Term Care Recovery After Complication From A Medical Treatment Complications After A Medical Treatment FAQs
Once people reach 65, the CDC estimates that they can expect to live approximately another 19 years. This growing segment of the population accounts for 1 in 10 of all surgeries performed in the United States, a number that is expected to increase as these trends in aging and life expectancy continue.
While many surgeries and procedures are being performed with more success than ever, a number of unique medical treatment complications and risks can arise for people over 65. Below is a comprehensive guide to these potential complications, and how to overcome them through various risk mitigation strategies.
Reasons Seniors Have An Increased Risk Of Complications After Medical Treatment
Seniors have increased risk factors for complications following surgeries for a number of reasons. 80 percent of Americans 65 and older have at least one chronic health condition, while 68 percent have two or more conditions. Many of these conditions can cause increased risks of surgical complications. Some of the most common conditions for seniors include:
- Cardiovascular (heart and blood vessel) disease, heart failure, and high blood pressure
The American Heart Association estimates that 70 percent of people over the age of 60 have cardiovascular disease. Cardiovascular disease, often called heart disease, is the number one cause of death in people over 65, with seniors accounting for 66 percent of total cardiovascular-related deaths in the United States. Having a preexisting heart-related condition can make it more difficult for the body to withstand a variety of surgeries.
It is common to have minor bleeding following surgery, but larger medical problems may happen that cause the bleeding. If you experience excessive bleeding, which may be caused by an injury to a blood vessel, please consult your physician.
- Diabetes (including pregestational diabetes and diabetic retinopathy)
Among people over 65, an estimated 25.2 percent have diabetes, according to statistics from the American Diabetes Association. Diabetes can lead to slow wound healing, which may cause major complications after surgery. Ask your doctor about further diabetes self-management education following medical treatment. Diabetic retinopathy is a complication of diabetes that affects your eyes.
- Respiratory (lung) disease
Around 11 percent of people over 65 have chronic obstructive pulmonary disease, or COPD, a common lung disease. Since surgical and pain control medications can lead to a decrease in respirations, the number of breaths a person takes per minute, this can cause serious complications in people living with lung disease.
- Previous strokes
About 75 percent of strokes occur in people over 65. A stroke can increase the risk that a patient will experience complications from anesthesia, including the risk of a suffering an additional stroke.
- Aging of the body and brain
As it ages, the body is more susceptible to complications from anesthesia, pain medications, and wound healing.
People who have dementia may take longer to wake up from general anesthesia and may experience increased confusion or delirium after its administration.
Anesthesia And Seniors
Anesthesia, which prevents pain during surgery, has different risk levels depending on the type of treatment administered. General anesthesia, the type of anesthesia that causes a person to become completely unconscious during surgical procedures, is the most likely type to cause complications in surgery patients. In monitored anesthesia, or sedation, a person is awake and does not feel pain, but is likely to feel tired or “out of it” from the treatment’s effects. Localized anesthesia consists of a numbing of only the specific area where a procedure will be performed. This is the type of anesthesia least likely to cause side effects in surgery patients.
While going under general anesthesia is generally considered to be a very safe procedure, complications, especially for seniors, can occur. Seniors are at increased risk for postoperative delirium, a temporary condition following surgery that may cause confusion, memory loss, and disorientation. A patient experiencing postoperative delirium may have trouble remembering what day of the week it is, why they are at the hospital, or other important information about themselves or their families. These effects can be felt for several days after surgery, but generally fade without any additional treatment. If long-term effects persist, contacts your doctor. But, a person who has experienced postoperative delirium will likely be back to normal levels of cognitive function within a week.
Postoperative cognitive dysfunction is a more serious, long-term condition. In postoperative cognitive dysfunction, known as POCD, the confusion, memory loss, and disorientation experienced by a patient are lasting and significant. The person’s brain does not recover fully from the anesthesia, and the decline in their functional ability is lasting. The risk of POCD is heightened in seniors, but can be difficult to accurately test, since cognitive problems, such as Alzheimer's and dementia, are common among the general senior population. People with dementia are at even greater risk for POCD.
Steps To Take Before Going Under General Anesthesia
There are several steps you and your family member can take to minimize some of the risks of anesthesia and to make sure recovery is safe.
- Have your family member’s primary doctor perform a cognitive exam on them before surgery. Cognitive exams consist of series of questions and tasks designed to assess a person’s memory, problem-solving ability, and awareness. By having this test performed before surgery, your family member’s doctor will have a comparison point for any confusion or delirium after the operation.
- Bring familiar items to the hospital with your family member. Pictures of loved ones, favorite pillows or blankets, or other comfort items can help orient people to their surroundings.
- If possible, request that your family member have a bed by the window and keep the shades open. The natural sunlight can help with awareness of day and time.
- Plan to have someone with your family member at all times. You or someone else who knows your family member well should stay with them as much as possible after surgery. This can help in multiple ways: seeing a familiar face can help to orient someone experiencing confusion, and a continual observer familiar with the patient will be able to spot any changes in their mental state.
- If your loved one uses assistive devices, such as glasses or a hearing aid, make sure they are returned for normal use as soon as possible after the procedure.
Fall Risks After Surgery
Falls can happen after surgery, both at the hospital and during the recovery period. Pain medication and the lasting effects of anesthesia can increase the risk of falling, as can any surgery that affects how a body part functions, such as hip or knee replacement. Around 45 percent of all falls within the first 30 days after surgery result in injury. People who have had a previous fall are at a higher risk of falling again after surgery. Even one fall in the six months before surgery can increase the risk of falling again after surgery and lead to a decline in overall function after surgery.
The risk of falls is already significantly heightened for seniors. The CDC estimates that one in four people over 65 fall each year. Balance, vision, medications, chronic conditions, and environmental factors can all lead to this increased risk. This already elevated risk of falling makes seniors especially vulnerable to falls after surgery.
Infections After Surgery
Surgery can leave the body open to infection, which is an increased concern for people over 65 due to potentially weakened immune system responses. Broken skin from surgery can easily become infected without proper follow-up care and monitoring. A localized infection at the surgical incision is known as a surgical site infection. These infections can be on the surface of the skin, in the muscles or tissues under the incision, or in an organ or organ space. While surgical site infections are rare, the risk of them increases in the elderly and in people who have a chronic condition.
In addition to surgical site infections, pneumonia and other internal infections can occur after surgery. Pneumonia is a serious lung infection that can be fatal among seniors. 21 percent of patients who develop pneumonia as a complication of surgery die within 30 days. Like surgical site infections, pneumonia is a relatively rare complication seen in only around two percent of patients, but patients over 65 are at an increased risk for the infection of up to 15 percent when combined with other risk factors, such as chronic illness or history of stroke.
Infections And Sepsis
Sepsis is a serious condition that can occur when the body responds to an infection. The body can release chemicals into the bloodstream to fight the infection, which can harm other body systems. Sepsis is very dangerous and can cause organ and system failure, leading to death. Patients who develop infections of any kind after surgery are at risk for developing sepsis symptoms if the infection is not properly treated, and this risk is increased in senior patients.
Infection prevention is vital to the success of the surgery and to your family member’s overall health. Your family member’s follow-up care team will watch for symptoms of all types of infection. Some important tips to keep in mind as you monitor your family member, even after they return home from the hospital:
- Look for redness, pain, or swelling around the incision site.
While some pain and redness are normal, pain, redness, or swelling that suddenly increase are not and could be a sign of a surgical site infection.
- Look for pus or other discharge around the site.
Discharge can be a sign of infection and should be reported to your family member’s care team right away.
- Make sure the covering or dressing over the incision site is being changed and cleaned.
Old bandages can hold moisture, allowing bacteria to grow and causing infection.
- Make sure your family member is up and moving as often as recommended by their doctor.
Walking, standing, and even sitting up can greatly reduce the risk of pneumonia. Making sure your loved one is not spending all day laying flat in bed is very important to reduce this risk.
- Check catheters often, if your loved one wears one.
Catheters are placed after surgery in patients who have had bladder concerns in the past, who are incontinent, or who need their urinary output measured. A catheter bag should be watched for any signs of infections, such as bloody, discolored, or cloudy urine.
Blood Clots After Surgery
After surgery, blood clots can develop. A blood clot is blood in the body that has become solid due to coagulation. All surgeries carry the risk of blood clots, especially joint replacement surgeries. A blood clot can cause pain, swelling, or tenderness. A clot that forms deep in a vein, typically in the legs, is called deep vein thrombosis. When a piece of blood clot breaks off and travels to the lungs, it is referred to as pulmonary embolism, a condition that can cause shortness of breath, chest pain, and even death.
Preventing Blood Clots
Your family member’s doctor and care team will likely have measures in place to prevent blood clots, such as:
- Regular exercise and physical therapy
Moving the body, even it is with the aid of a nurse or therapist, can prevent clots. Walking around is one of the most effective ways to avoid clots.
- Elastic stockings
Stockings that provide pressure around the leg, sometimes known as anti-embolism stockings or TED hose, help promote blood flow and prevent clots.
If your family member is at high risk for clotting, they will likely be put on an anticoagulant medication. Anticoagulants act by thinning the blood, which prevents clotting.
After A Medical Complication
A medical complication can leave you and your family member feeling frustrated and confused and can have significant effects on their recovery and their ability to care for themselves. Your family member may feel angry, scared or even depressed as a result of experiencing complications after surgery. Depression can commonly occur even after successful surgeries, and the risk of developing this condition after a surgery with unexpected complications is significantly increased. In addition to the emotional toll, the complications may cause your family member to no longer be as independent as they would like to be. They may be hospitalized for much longer than planned or require long-term care.
Things You Can Do To Prepare For Complications After Medical Treatment
Unfortunately, many medical complications following surgery arise quickly and cannot be planned for. While you may not be able to predict a surgery complication, you can take some steps to prepare, putting preparations you may need in place and giving you and your loved one greater peace of mind.
- Talk to your family member before surgery about their care preferences. Ask them if they would feel comfortable going to a long-care facility or receiving in-home services. Knowing their care preference can help you make a choice if you need to.
- Make sure your family member has an advance directive or living will filled out. An advance directive is a written statement of what your family member wants to be done for them medically in the event they cannot speak to medical personnel for themselves. Forms for advance directives in each state can be found here.
- Help them designate a healthcare power of attorney. A healthcare power of attorney is a person, selected by the patient, to act on their behalf when it comes to medical decisions if they are unable to do so. A healthcare power of attorney is different than a standard power of attorney designation, because it covers medical choices rather than general financial ones. It is important that the healthcare power of attorney be a trusted person who will act with your family member’s best interests in mind.
- Help them designate a power of attorney. Having a power of attorney designated be very helpful if any long-term care decisions need to be made. This person can fill out paperwork, sign documents, and handle other matters for your family member when they are unable to do so.
- Plan for any financial needs that may come up. The period before surgery is a good time to look at your family member’s finances and insurance policy and figure out what they would be both expected to and able to pay for any needs after surgery.
Options For Long-Term Care
If your family member is no longer able to care for themselves following the complication of a medical treatment, you may need to consider long-term care. Home health care, skilled nursing care facilities, and assisted living facilities all provide care for people who need assistance with personal and medical care.
Home Health Care
If your family member is still able to stay in their own home, home health care may be the best option. Home care can aid recovery and help people feel more independent and more in control of their surroundings. Home care allows people to be around familiar objects, places, and loved ones as they receive the care they need. For people who live with a spouse, adult child, or other loved one, home care can be beneficial for both the patient and the caregiver. Home health staff can teach family members how to provide needed care or help with the tasks of daily living, such as bathing or dressing.
When using a home health care provider, your family member will have a care team. This team will tend to their needs and help them recover as much as possible. A nurse will check their incision site, monitor any complications they are having, administer medications, and provide any needed treatments. A home health aide will help them bath, dress, and use the bathroom. Other professionals, such as physical therapists, occupational therapists, and speech therapists will also be part of the team and will treat your family member at their home. A home health agency will also help you and your family member get all the equipment they need for safe daily living activities within their home.
It is important to keep in mind that home health care is not a 24/7 solution. If your family member lives alone and would be unable to care for themselves due to medical complications from surgery, home health care would not be a safe choice for them.
After your family member leaves the hospital, Medicare will pay for 100 percent of home health care costs as long as the agency is Medicare-certified and as long as a doctor certifies that the need is both part-time and temporary. Medicare will generally pay for care that is needed for less than eight hours a day and that is expected to last for 21 days or less. Medicare will also pay for any durable medical equipment your family member needs, such as raised toilet seats, shower chairs, or walkers.
If your family member will need the services of a home health agency for longer than Medicare will pay for them, you may need to look into additional payment options, such as Medicaid, PACE programs, long-term care insurance, or private pay.
Skilled Nursing Facilities
Skilled nursing facilities provide around-the-clock care from a team of professionals. This team includes nurses, nursing assistants, physical therapists, recreational therapists, respiratory therapists, occupational therapists, speech therapists, dietitians, and social workers. Staff at the facility will help your family member recover from the complication of their medical treatment.
Physical and occupational therapists will see and treat them in therapy suites or at their bedside, depending on their ability level. A speech therapist may see them to help with language or swallowing. Nurses will complete any needed testing and medical treatments. Nursing assistants will help them eat, dress, shower, and move around the facility. Your family member will also have a physician assigned to them who will oversee their care at the facility.
Additional staff, such as a respiratory therapist, may see your family member to administer breathing treatments and check their oxygen levels, especially if your family member contracted pneumonia following surgery. A dietitian will make sure their meals follow their doctor’s orders and that they are in keeping with any religious or cultural practices your family member may have. A recreational therapist can help your family member socialize and relax. They may ask them about their favorite hobbies, bring them activities such as books and puzzles, introduce them to residents with similar interests, and invite them to facility-wide events.
In a skilled nursing facility, your family member may have a roommate. They may sometimes need to move rooms within the facility as their care needs change. Staff will help them move their belongings if this occurs and will notify you or another listed contacted person, often a power of attorney.
Medicare will cover 100 percent of a stay in a Medicare-certified skilled nursing facility for 21 days and will pay a percentage of the costs on days 22 through 100. If your family member still requires skilled services after that point, you will need to look into Medicaid or private pay options.
Assisted Living Facilities
In an assisted living facility, your family member can receive help with the activities of daily living and with their needed medications while still maintaining some independence. Generally, assisted living communities will assess a potential resident to decide if they are able to provide the care needed. These assessments include physical, personal care, and cognitive assessments.
Assisted living facilities do not have the staff of skilled nursing facilities or home health care provider. Personal care assistants will help your family member with getting in and out of bed, bathing, dressing, and other activities of daily living that they require. Different assisted living facilities will have different requirements for what your family member needs to be able to do for themselves to be admitted. A nurse, usually an LPN or a medication technician, will assist your family member with their medications and with treatments such as eye drops, inhalers, and insulin shots. Staff at an assisted living facility is not able to provide skilled care services.
Residents at many assisted living facilities have private rooms or suites. Housekeeping services, food, maintenance services, and laundry are provided in most assisted living facilities. There is usually a full calendar of activities they can participate in, often including outings to local shopping or restaurants. Assisted living facilities can be a great choice for people who want to maintain a level of independence but who need help with daily activities and feel safer when caregivers are available 24/7.
Assisted living is not covered by Medicare. Long-term care insurance, Medicaid, and private pay options can be used to pay the costs for this care. Some assisted living facilities have different levels of care provided on-site. Each of these levels of care may cost a different amount. Make sure you know all of the associated costs of the facility you and your family member select before moving in.
Recovery After Complication From A Medical Treatment
After facing a complication of a medical treatment, everyone’s recovery will look different. The outlook will depend on the type of complication, the overall health of the person, the care they receive afterward, and other factors. By making choices that respect your family member’s wishes while also keeping them as safe as possible, you can help them in their recovery. Complications after procedures can be frustrating setbacks, but they do not mean your family member cannot recover or live a full and happy life.
Complications After A Medical Treatment FAQs
1. Is it safe for seniors to have surgery and other medical procedures?
Yes! While there are risks and complications associated with procedures, they are rare. Many procedures have seen increased success rates in recent years as new technology has been implemented. While seniors do have an increased risk of medical treatment complications, they can also see a great number of benefits from operations and other treatments. Only a doctor can say if a specific procedure is safe for a specific patient, but in general, most procedures are very safe.
2. What is the difference between a medical complication and medical malpractice?
A medical complication is the result, or side effect, of a treatment, surgery, or other procedure. In many cases, factors such as the patient’s age, overall health condition, and weight increase the risk of complication. A complication is not normally caused by anything done by any medical professional. In medical malpractice or medical negligence, it is provable that something a medical professional did, or did not do, caused the unintended consequence. While these things can overlap, most complications occur as the result of normal procedures, not ones that were poorly done.
3. Why should my family member have a living will or advanced directive document?
An advanced directive, or living will, helps make sure your family member’s desires for their own care are known in the event they cannot communicate with medical personnel. They can elect what treatments they do or do not want, in the event they are not able to verbally make these choices themselves. Knowing this information before something happens can help everyone feel sure that any care being given at a hospital or facility is what your family member would request.
4. How can I approach a conversation about living wills, power of attorney designation, or long-term care with my family member before surgery?
This can be a difficult conversation, but it is an important one. Your family member may be angry, defensive, scared, or sad about the idea of planning for something to go wrong. These feelings are normal. You should plan to have the conversation on a day when you both have a lot of time, so you can slowly work through those feelings and begin to plan for the future. Emphasize with your family member that you may not need these plans, but that having them in place will make you both feel more secure headed into the surgery. Tell your family member that it is important to plan for these things now so that you can make sure their wishes are being followed at all points during their recovery.
Proximity of care is very important when considering options
Research care options that are nearby when thinking about the next step for your loved ones.
Leona J. Werezak RN, BSN, MN is a registered nurse and adjunct nursing professor. She has 24 years experience working in a variety of healthcare settings including such remote locations as the Arctic Circle. Her research in early stage dementia was published in the Canadian Journal of Nursing Research and re-published in their 40th anniversary issue which showcased exceptional research published since the journal began. Her work in dementia care has also been published in the Journal of Gerontological Nursing. She currently teaches surgical nursing care on a thoracic/vascular unit to baccalaureate nursing students. Her clinical work with nursing students involves extensive work with older adults who have multiple chronic health conditions.