Depression and Anxiety After Surgery

by Jan Allen, CSW, MSE
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I received this email from a friend.  I have "de-personalized" it and include it here. I
thought some of the issues my friend asked about were similar to what others might be experiencing.

My grandma is having breast cancer surgery tomorrow.  I know they're taking a good part of the breast because the tumor has gotten significantly larger. But Grandma is 91 and is not remembering things...

They moved her into a nursing home a couple of weeks ago.  She had a mild stroke and got more confused, and it finally became clear that she couldn't be by herself even with a couple of visits per day by my mom/aunt/uncle.

How would you deal with someone in her mental state after mastectomy? Also--a number of years ago, the doctor said to my grandma, "Henrietta, are you depressed?"   Her reply was, "Of course I'm not depressed.  I'm a Christian."

But I know there's significant anxiety there because she cannot keep track of things.   And she's not happy where she is although she doesn't seem to remember the apartment she was just living in up until a couple of weeks ago. Any suggestions re:   meds evaluation?  Where to go?  Who to see?

There are activities at the facility, but Grandma doesn't want to participate. That's another thing that leads me to think there's some real depression there -- She has always been very shy and socially somewhat awkward. Wonder how many years have been her suffering silently from her own unacknowledged depression.

Anyway, any insight or suggestions would be helpful!

My responses to the above inquiry:

1.  We always suggest a thorough medical work up when dementia starts to set in.   Even though grandma is 91, she may have clogged arteries in her neck - not Alzheimer's -- so it is good to do a complete physical and history.

2.  Most parts of the U.S. (in the larger cities) have some kind of geriatric assessment clinics. She can get more than the "average" GP type of exam at those places including an assessment of cognitive function.

3.  After surgery, I am a firm believer in medication for anyone, especially folks with dementia.  I would encourage keeping her sedated - not just for pain - but also for the anxiety and confusion - until she can better deal with things.

4.  WARNING:  folks with diminished cognitive awareness do not handle change well. She has already gone through a massive change of leaving her home and going into a NH.  Now, she is going to have more changes on top of those changes.  When folks with limited awareness go through change they sometimes become horribly upset and disoriented. There is just too much stimulation for them to endure.  So, expect that things will be a little rough for a while. It would not surprise me if the hospital wants to "tie her down" to keep her from pulling i.v.s etc.  Someone needs to advocate for her in these regards.  I am not saying to argue with the medical staff; but someone needs to hold them accountable and ask about options before she is restrained.   I can assure you of this:  things will improve once she is back in a (fairly) familiar surrounding and once she stabilizes and has little or no pain. See a related article by Geri Hall

5.  Nutrition is very important at this time as well. Try to get her to eat and drink as much good food as you can. Nutrition can really help with cognitive functioning.

6. Regarding the depression issue:  It's really hard to say if she is "naturally" shy and withdrawn or depressed.  If her personality is naturally one of being non-social, there is little that can be done. I must admit I have a little bias here - I do not think Prozac is great to give older folks - if that is ONLY what is done.  I think older folks need counseling, love, TLC, encouragement and someone paying attention to them regularly and consistently - AND Prozac when needed.   There is proof that anyone who is depressed does better with a combination of drug and counseling. However, "counseling" can take many forms with older adults.   In the nursing home where I worked, when an elder did not wish to participate in group activities, I brought the activities to them.  I had a cart filled with all sorts of "stuff".  Hand lotion, nail polish, books, games,  pictures, puzzles, music tapes, etc. and I would come in and offer to read, play a game etc. in their room. This was my way of helping them to get comfortable with me and maybe take a chance at a small group activity.  Since your grandma is in a NH, she MUST have a care plan.  That care plan MUST address
social/activity issues.  Perhaps someone can ask to review her plan of care and see what goals have been set.  Gradual introduction to activities sometimes works with shy, withdrawn folks.  Also:  many older adults are reluctant to leave their rooms for fear of missing a visitor.  If they are absolutely assured that if anyone comes to visit, the staff will direct them to the activity room, they are much more likely to be willing to leave their
rooms.  I also developed a number of small group activities for folks who didn't want bingo, etc.  These small groups were far less threatening.  I also did some half hour programming to give folks a sense of security that they would only be gone from their rooms a half hour - lots of things like that.

Hang in there. I believe things will improve.   Jan

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