My mom was having a not-feeling-great-but-nothing-specific day not long ago (she in is mid-stage dementia, so she can't really be specific, doesn't even know her name anymore), so I took her to the doctor. All the usual labs done, nothing out of the ordinary. Doctor listens to her heart. Mother has had a slightly irregular heartbeat for a while, but Doctor detects maybe something different. She got an EKG. Nothing shows up. We are sent to a cardiologist to be on the safe side. Cardio doc spends 5 minutes with her and wants her to do a physical stress test. His assistant, who spent 30 minutes with Mother, and I tell him that's not a good idea due to her physical instability (she's on the verge of needing a walker). He agrees to a chemical test instead, and wants her to wear a heart monitor for 24 hours. Mother is in assisted living, so you can imagine how long the monitor lasted. I imagine they got 8-9 hours of feedback before she ripped it off.
Fast forward to a conversation yesterday with a friend (73 years old, otherwise good physical and mental health) who is getting a pacemaker due to an arrhythmia discovered during a physical stress test. He's describing the procedure and aftercare to me and it dawns on me that this is a possibility for Mother. For him, it's very doable and makes sense. For her?? Then I hear from my sister after a conversation with her best friend about her own 89-year-old mother who has been getting annual chemical stress tests and friend is questioning why? Mom doesn't have a heart problem. Is it just because Medicare will pay for one annually, so why not? Mom, who is a tough old lady, also describes the test as making her feel like she's going to explode.
I'm trying to prepare myself, and my siblings, to make some decisions. So, finally, my questions:
1. Does anyone have experience with the chemical stress test? How do you think a dementia patient would fare? Is it worth it?
2. If we do the test and a pacemaker is recommended, is that a good idea? I've been reading some really sad stories of people in total decline whose hearts just keep on ticking. And there seems to be a lot of confusion and conflicting info on getting one turned off if it comes to that.
3. If a pacemaker were installed, the procedure sounds simple enough, but the aftercare would probably require skilled nursing for a short time. What's the likelihood that all of this together is just going to send her into a further decline? Does anyone have experience with that?
4. Is this all overkill? We're getting into a new area in Mother's care that will require us to make decisions in her best interest, including maybe NOT doing something. I don't want to go down the road of having things done just to say we did, so we won't feel guilty or like we're being negligent. At what point in the life of a person who doesn't even know themselves anymore do you just say no? We don't want her to suffer, and she's not - she just doesn't feel like running any foot races.
5. We have her Medical Directives and we're all alternates on her Medical POA; has anyone had problems executing powers in the face of medical recommendations?
Thanks in advance for any and all input. I'm pretty sure of my thinking on all of this, as are my siblings, but would especially appreciate anecdotal feedback.
GA
I was surprised, too, but at the time accepted that he "knows what he's doing". I live in a small town, and when I mentioned this at work, a co-worker said "Oh, Dr. so-and-so's dad is nearing 80 but he's a marathon runner, really active, so that's the doctor's experience". Then the other incidents I talked about above made me question even more.
In my research I came upon the following article. I realize that it's about one family's experience, but it gave me some things to think about. It's very well written.
https://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html
What treatment would be changed by the results of the test? If you decide that you would not want a pacemaker or other surgical options then there's no reason to have the test.
There are some studies indicating that anesthesia causes significant declines in dementia patients although for some reason it doesn't seem to impact vascular dementia patients to the same degree as other forms of dementia. If she has a pacemaker implanted she may not have any more periods of irregular heartbeats but she may skip a stage on her dementia journey and be much less functional afterwards.
I suggest discussing medications that might help with the irregular heartbeat before considering either a stress test or a pacemaker. My retired nurse great-great aunt choose at 92 to endure occasional episodes of irregular heartbeats instead of more aggressive treatment. She died in her sleep more than seven years later just two months short of her 100th birthday.
For anyone with mid or advanced dementia I believe in providing basic medication treatments (blood pressure, thyroid, diabetes, etc.) and comfort care to reduce or eliminate pain while avoiding other tests and treatments.