My dad has dementia and has lived in a memory care facility for over 2 years. He is frail, beginning to have trouble walking, and is almost non-verbal. When of sound mind, he filled out DNR paperwork and made it clear to me he would not want to live beyond "quality of life". He even spoke of suicide/assisted suicide. He always said he would not like to end up like his mother, who spent her last years bedridden with advanced dementia.
Dad is 81. Lately there has been some discussion about him possibly needing a pacemaker. My reaction has been "No". If his body winds down naturally and he dies a peaceful death, I think that is what he would have wanted.
Part of why he was moved to memory care is that my alcoholic mother refused to care for him and said he was "not her responsibility" after 50 years of marriage. She has verbally abused him and has said many times he would be better off dead, she wishes he were dead, etc. I am generally the one that nursing staff looks to for dad's needs, although technically mom is first in line as POA. Mostly she is AWOL :(
This morning we briefly discussed the pacemaker issue and she says her answer is "Yes" to the pacemaker, if that is what the doctor's suggest.
OK: Thoughts from the Forum about pacemakers, Please!.....
I am a nurse. I would vote for honoring your father's wish. I would not place the pacemaker. I would be doing palliative care only now.
That's where I stand, but when someone ELSE has the power of attorney it doesn't matter where you stand. I would gently advise Mom that Dad would not have wanted this, and that his wishes should be honored. But really, that is the only power you have.
Pacemakers are not benign procedures and there is then the side problems of getting them checked, adjusted, medications, etc. That said, the procedure usually goes well and they are more and more sophisticated with less and less problem of battery changes, etc. The problem with the elderly is that during that window of time waiting for the leads to kind of implant (think of a fishhook to the chamber) with scar tissue, a radical movement can displace the leads. In the elderly impaired this can happen more readily than with the young. I do not know the reason for pacer. I have Chronic Atrial Fib which my spouse has also. I chose no pacer and he chose yes. He is in fact on his third battery change in a few months and I am still beside him. His was placed for a slow heart beat, and more problematic thing. There are many different reasons to place them, just to tell you I am about 20 years out with chronic fib and an aspirin a day. So far still here. It's a spin of a wheel chance whether you do it or don't do it, as to which would give best quality of remaining life.
IMHO
The incision is painful. I am not sure if I would put an elderly person thru this.
POA bro decided to ask mom, who was still technically competent, if she wanted Pacemaker, explained procedure and that doing nothing would result in death. She paused; clearly thought about it and said "yes, I want to do it".
So we did it. Awful night in ICU with temp PM; they didn't give her her antianxiety meds; after surgery, she woke up and said "Kentucky Derby!!". (The Belmont was the race that was being run that afternoon; she was "in the ball park" shall we say.
She lived another 2 years. Was it the quality of life I would have wanted for her? No. But we asked her and she said yes.
Ask your dad, if he hasn't been declared incompetent. It's HIS decision.
If all else fails, and you have evidence of your mother's abuse of him, get emergency guardianship for your father. Your mother should not be in charge of him; she does not deserve that privilege.
I think that your dad made his choice plain and clear when he was of sound mind.
Your mom, who knows what her motivation could be in having him go through a procedure that inserts wires into his heart, this is not an outpatient procedure. I can only think it is money.
At 81, with dementia, doing anything that will prolong the very existence he didn't want would be cruel in my opinion.
Try to discourage her from having this done.
Hugs! What an awful situation.
My experience appears to have been different from some of the other posts. I can think of three loved ones I’ve been up close and involved in when they got their own PM.
No problems at all.
One with Parkinson’s and dementia had hers replaced after going on hospice and all concerned are glad she did.
However, In your dad’s case, I would follow his wishes.
I would also try to get his POA from your mom. You might have missed your best (easiest) opportunity for that when you took his care over.
Regardless, I think I would impress upon her that if you have to file for guardianship of him that the funds to do that will come from his bank account.
She’s got quiet a record now you could mention that shows she isn’t really the best decision maker so a simple letter stating she will no longer be his POA would be the appropriate step for her to take. You shouldn’t have to deal with her over his care.
Your attorney could provide that document. Of course I wouldn’t go that far unless forced to.
I would think he was a drain on her finances unless he has a good LTC policy that’s paying for everything.
She has been so cruel to him (or is demented herself...can’t have it both ways), that I would want to protect my dad to live his life out as he saw fit.
This one is not hard to decide to me because you know what he wants.
I don't know the first thing about pacemakers, so I feel that I need to be armed with real data to understand the short-term and long-term implications in having one placed in an 81-year old frail man with dementia. I fear for his future, and frankly mine too sometimes. Covering all bases with a dementia dad and a mentally ill mother is draining :(
Your father made it very clear what he wants. Time to speak to doctors about your mother’s alcoholism and just kick up a stink. Time for an argument with your mother Do you think she knows this will hasten his end? Can you go to the home administrator? Just keep making as much noise as possible till they give it up
Years ago my 97 year old great uncle (no dementia) fell because his heart rate dropped. Although he had a DNR, the doctor talked us into a pace maker. Unfortunately because my uncle had broken his hip in the fall, he went from hospital to rehab to nursing home. He had been living at home and was never going to be able to go back. His final months were not what he would have wished for and I wish we had said no to the pacemaker and followed God’s plan for him.
Will it make him more comfortable? Will it change his eventual outcome? How will it effect his Quality of Life? He has next to no quality now and doesn't wish to let his heart keep beating if it wants to quit.
There are many follow up appointments after the surgery to consider as well. If my mother with dementia at 92 were to be faced with getting one, I'd refuse. Prolonging her life when the quality of it is shot seems like a silly option at this point. All we do is go back and forth to ERs, hospitals and rehab as it is, nevermind adding ANOTHER issue into the mess. Again today she asked Why Am I Here ?after taking yet ANOTHER fall this week. She's already in a wheelchair and suffering several other chronic health issues in addition to dementia and living in memory care. There are people here who will insist that EVERY medical intervention should DEFINITELY be taken to prolong your mother's life for even ONE more day. I question the compassion of that logic and challenge the notion of it having anything to do with love, but being a fear based reaction instead. Sometimes love means knowing when to let our parents rest in peace and THAT is a true act of love. And faith prevents us from making fear based decisions because we know that life, in reality, is eternal.
Wishing you good luck and Godspeed with your decision, my friend. All the best
Having a low HR can make the person tired, scared to stand up as he may get dizzy, etc. I am of course not familiar with your dad’s history. But having a pacemaker may indeed improve some quality of life.
I would look into pacemaker insertion. Yes it’s tricky in the beginning but hopefully with family support he will get through it.
I am aware he signed a DNR. This is a tough decision but if you feel the procedure is just too much or the risks involved are too high.
Pacemakers fire electricity to help the heart beat as it should, but a pacemaker in and of itself will not make a dying heart muscle beat. If someone with a pacemaker has a heart attack, the pacemaker won’t keep the heart going. If the heart muscle is dead it will not “pick up” the paced beat and continue beating because the conduction area in the heart (SA node) is dead so if this is a concern of yours speak to your father’s providers.
Good luck in your decision.
My mom has a pacemaker and they also recommended a defibrillator. Personally I wish we had not done the defibrillator part of it. The defibrillator will set off if her heart stops and try to start it again.(it sends an electric shock) It's been in her for 3 years and it's not gone off once but now that she's 89 it will still go off even if it's her time and her heart has had enough. I don't think that's going to be a peaceful death. I asked the Dr later what happens when she gets to a point in her life when her heart wants to stop. (I mean 90 is kinda there it's suppose to at some point.) He said to me she will not die of cardiac arrest. Which means to me that the defibrillator will keep shocking her till her heart starts again. I don't see this as a good thing for someone in their 90's. It's would be even worse if quality of life was not there, alzeimers for instance. What would be the point?
I would be very frank with the dr. What is the reason. To prolong life or to make life manageable?
At EOL (end of life) you will have to have it shut down or it will keep "zapping" his heart.
He has expressed his wishes in the fact that he has said previously that he did not want extra measures taken. I would consider the insertion of a pacemaker an extra measure. AND...while being operated on the DNR will be "suspended" so if he does arrest during the procedure they WILL do CPR, they will shock him and the great likely hood that doing CPR will break most of the ribs and possibly the sternum this will cause him great pain during recovery. A recovery he may not fully complete.
I would opt not to have the pacemaker put in.
Ask the Doctor..."if this was your Dad knowing what his wishes are would you proceed with a pacemaker? Will this actually IMPROVE his QUALITY of life not just PROLONG it?" (if it would actually prolong it at all)
I dont know what my mother will choose to do. She is still of sound mind. She would be afraid of the unknown and would probably choose to have the device replaced. It would be done by local anesthesia. She would be afraid to just let her heart slow down to a pace where it may just stop one night in her sleep. I don’t know, but these are things that must be thought of when determining if quality of life will improve or not. The new device will not cure my mother’s chf or her skin cancer.
These devices are good for those who have yrs ahead to look forward to. Otherwise, I feel they add to the patient’s burden and also the burden of those who care for them. I have taken care of my mother for over 8 yrs. My own health is in jeopardy. I was diagnosed 2 yrs ago with stage 2b NHL. Hospice is a God-send, but they do not do everything and my mother is not in hospice for her skin cancer. So we still have to treat outside the home every month for this. There is much to consider. Perhaps the staff social worker can help you? Doctors will want to do the procedure - they don’t have to deal with what follows except for their professional part of follow-up appointments.
Why does he need it? Will it actually help his quality of life or just prolong what he told you he did not want? Given his current medical condition, dementia issues, and what he said he wanted - ask doctor directly what he recommends.
Maybe if your mom hears all of the details, she will have second thoughts on what to do.
Your dad may not be able to comprehend what he would agree to. It's very scary to me that your mom is first in line as POA...if that's what he has done, knowing she has problems with alcohol...that is a messy situation and I'd be seeking some legal advice. If that's true, you do not have any control...IF it is legal and IF it is medical POA that she has.
Do ask questions in re to the actual pacemaker procedure. It may help you decide. Some places/MD's get very concerned in re to anesthesia and older people. My Dad is in great shape...but after his 100th birthday, less than 2 months later, he didn't feel good and turned out to have a heart rate that was a steady 35 BPM. He is very vital, capable, involved (now at 102 he continues). So he was very agreeable to a pacemaker. He was admitted to the hospital around midnight, they did the procedure as I recall around noon the next day, he was back in his room within 2 hours and eating Chick Fil A an hour after that and home 24 hours or less after. BUT, and this is a significant BUT....we were not informed that the procedure would be done with local anesthetic and very little in the way of other medications apparently. He described it as the worst pain he has ever endured (and he's been through some significant). Just by how often he initially talked about it, I knew he had been traumatized by it. I had a friend (oral surgeon) who said but he IS here to talk about it, and that's what matters. The surgeon who did it very gently conveyed something about it but I translated: the gist of it was that too much anesthesia at that age and with that heart rate could have taken him. Would he/we agreed if we had known? I would have at least braced him for it. And I would have contacted other MD's to confirm this was the right way and the only way to proceed.
It seems to me you dad was pretty clear when he discussed things with you, and that your heart is leading you in the right direction. There is a company to help sort medical decisions out called Curadux. A wonderful (imo) doctor who used to be chief of anesthesiology at Cleveland Clinic started it, inspired by his own critical illness. He's as compassionate as they come and they will explain if insurance can cover the cost of a consult.
Wishing you all the best...