PM for octo & nonagenarians

any one have hopeful words for nonagenarians getting PMs?
I have researched everywhere and only one study from 1996 that correlated effects on funcional independant living post PM implants in 80 & 90 yr olds. It wasn't very encouraging.
Anyone have better news?

15 Comments

I hope this is more encouraging

by jane32 - 2012-05-15 09:05:14

I know of a little lady who got her pm in her late 90s and is still living a good quality life at 102. I can ring her daughter if you want any more information regards her reason for getting pm. Hope this helps.

From an 82 yr old

by ElectricFrank - 2012-05-16 01:05:57

I'm 82, and have had a pacer since 2004 for AV Block. Without the pacer I would be dead or severely disabled with a HR of around 30. As it is I am very active and pursue camping, hiking, Jeeping, and generally do most anything reasonable for someone 10 yrs younger than I am. I'm completely independent.

Having said that the pacer is only a part of where I am. I was in otherwise good health at the time the block occurred so the pacer just restored that condition for me. There's no way the pacer could improve my overall situation.

For me having a good quality of life is far more important than quality. I realize that my choice of some of my activities puts me far from medical assistance. I avoid unnecessary medical procedures such as chemical stress tests, and colonoscopies with their attendant risks. The trade off is accepting that some of my decisions could shorten my life span.

I don't know if these are hopeful words, but for me they are reality.

best,

frank

Don't expect too much from a PM

by IAN MC - 2012-05-16 03:05:38

Hi Shebee ... I'm sure there are thousands and thousands of people in their 80s and 90s enjoying a good quality of life with the help of their pacemakers but it would be wrong to necessarily expect the same for your father. A PM may turn around his life but may not.

His hearing problem is likely to get worse rather than better, his memory loss , too, will more-than-likely get worse. People may reply and say " Ah but the memory loss may be caused by lack of oxygen to the brain and the PM will help oxygenation of the brain " ..OK, but unlikely to help memory much in my view... so in all honesty he MAY end up with a well-controlled heart sitting in a nursing home in a wheel-chair.

The other side of the coin ... the statistics that you quote, seem to be nonsense to me as are so many statistics. For example there is no reason on earth why having a PM should affect the likelihood of having dementia or orthopaedic problems

From what you say he appears to be losing the will to live for all the reasons that you describe, will a PM reverse this ? maybe, maybe not.

I'm sorry if I sound negative,I don't mean to but a PM would only solve one of your dad's problems...his falling heart rate to dangerous levels . Only you and your dad can decide on whether that one change will make a new man out of him . If you go down the PM route I sincerely hope that it does

Best wishes

Ian

for Ian

by SheBee - 2012-05-16 09:05:39

Thanks, you all for your responses, I welcome everyone's thougths on the matter.
I thank you, Ian, for your honesty and forthright response.

As to the stats from the study, they weren't very clear as to how long after a person got a PM did those things occur.

Docs at the Mayo Clinic did the study I referred to.
I think their conclusion was same as yours, Ian, not to expect much because the other parts of the body are still failing...they didn't say that the PM caused the problems only that those things occured at those % rates after elderly people got PMs. There study was not cause but functional independance correlations.

I think they were pointing out the same thing as you, that quality of life is not guaranteed by a PM for people that age. Most studies only look at survival rates, which are nearly 100%. Survival isn't the issue, as I am a realist and I think my Dad is too.

Ian, You don't sound pessimistic to me, just realistic.
The other thing is that Dad's problem is a high heart rate not a low one. If I animize his heart, it seems to be saying "I am done! Lets use up all the heart beats and be finished." Not very scientific at all or realistic of me.

But whether the problem is a high or low HR, a PM will regulate his heart rate, and definitely keep it ticking longer than it will if nothing is done. I just don't see that being the best option for his life.
I want hope that it will improve or that he will be satifies with it being the same as it is now, but there are no guarantees.

Thank you all for helping me process thru this.
A friend told me the questions for Dad to ask himself is, "Do I want to live longer the life I am currently living?" and "Do I wnant to live longer, knowing my other body parts will continue to wear out, even if a PM keeps my heart going?"

I don't want him to think that I want him to die. But I want him to make a well informed choice for himself.
Even his doctor seems to just want to avoid the inevitable as long as possible, without thought to what Dad really wants. Sometimes it seems the docs are mostly invested in longevity.

Again, thank you All!

encouragement & hope

by SheBee - 2012-05-16 09:05:55

Jane 32, If you don't mind calling your friend, I would like to know, not the reason the 90 yr old mother got her PM but rather, how active a person she was when she got it? And if she'd take my dad out dancing after he gets his? or even if he doesn't.

80 plus

by Ger - 2012-05-16 10:05:19

HI.......I'm over 80 and had a PM installed 1/12/12----have bradycardia, A-fib, SSS, and had a TIA last Sept. but am still doing OK....... Have a tee-time tomorrow at 9 am... Maintain my own home-----my mate died a year ago after nearly 60 yrs.......think a lot has to do with genetics........right now, as long as I have a good quality of life, am not interested in living to 100 years old.........Just like my lifeas it is right now......
GER

hope 4 90+yr olds gettomgPMs & life

by SheBee - 2012-05-16 12:05:45

Thank you both for the encouragement.
My fear is that my dad who has long been hard of hearing and that disability is getting much worse, has serious memory loss (but not Alzhemers), is already on oxygen when he sleeps, and has been losing his balance, but has taken no falls, is going to get a better
Dad was fairly active up until last year, though he'd lost interest in their many road trips. Last year was the first year he didn't garden, but his wife of 68 yrs, my mother, went into hospital in mid May with bowel obstruction, had surgery, which she survived, had good and horrible days, lost all her strength and confidence in her ability to hold herself upright, and finally succumbed in early July of bowel obstruction due probably to small blood clots blocking blood flow to her intestines.
My dad asked me to not let his doctors do to him what they did to my Mom...it is such a hard call to make. He knows that without the PM, his heart will quickly wear out and he will die, and he's had a rich full life, but still it is a hard discussion to have with him.
I don't want him to end up with a strong heart sitting in a wheel chair in a nursing home, not knowing his own family (he already doesn't recognize his grandchildren). But on the other hand I have hope that a PM will give him a new lease on life. He was only recently diagnosed with a very high HR (140), and atrial fib. Medicine/pills and a shock to his heart have not fixed that. Some say his heart was broken with Mom's passing and this will give him some spring in his step. But reality is his quality of life has been declining, long before this diagnosis. Most of his days are drinking coffee, eating cookies, reading newspaper & napping, then re-reading newspaper or books. But he also drives himself to church, ball games , grocery store, etc.
His first reaction was to not get the PM and fade away, but doctor and others kind of scared him, saying he'd have multiple visits to ER before he expired. So he agreed to the PM, but still has time to decide otherwise.

That study I found from '96 said that a 45% of people over 80 getting PMs end up in nursing homes, 34% have onset or increase of dementia, and 26% develop ambulatory/orthopedic disability. Those are hight risks in my mind, but they might have done so anyway, or they might have died instead. Again the question of quality vs quantity of life?
So, I guess question is, does anyone have experience similar to his; tachycardia, atrial-fib, 90+, still independant?

What I want

by ElectricFrank - 2012-05-17 01:05:32

If I get to the place where I am no longer interested in surviving, or if I choose to live on in the face of discomfort the one thing that is important to me is that my wishes be respected. I don't want anyone including family deciding what is good for me. I'm certainly willing to talk things over, but in the end it is me that makes the decision. The fact that I may not be able to think as clearly isn't a reason for taking over for me. In fact that is a time where I need support in deciding.

The doctor who pointed out that the lack of a pacer would lead to a number of trips to ER before finally dying has a good point. Our defective hearts don't always just quit.

I respect your thinking this through while you have the chance, and send my best wishes.

frank

Wishes Respected

by SheBee - 2012-05-17 03:05:02

Wow! what a great group you all are! I really like the way Frank described his choices and is so clear about his desire to not have anyone else deciding for him at any point, although sometimes it does get to that, which is why there are advance directives forms available in most states, in which we select someone to make our decisions for us if we cannot, i.e in a coma. I have filled mine out.
Being our own deciders is on my agenda for my Dad and myself. I just want to give him support in making his decisions, not lead him one way or another, or have him think I am trying to lead him one way or another, but give him the facts, the options, the alternatives, and point out to him that the decision is all his and that whatever he chooses I support.

With a friend last year, who had a terminal illness, I had to accept that not making any decisions, not filling out an advance directive or choosing a medical POA was a choice also. It was his choice to leave it in the hands and decisions of a medical team.

And my mom, who also was reluctant to decide about ADs and MPOAs, demanded a DNR one night while in her last hospital stay. She did not want to go thru any more heroics, but it took her going thru many of them over a few weeks, before she reached that place. It seemed very empowering for her when she made that decision. And she had some very great days after that, but she never took off her DNR wrist band.

GER, I so wish my Dad was up for some golf! Its been a few years since he took a walk or rode his bike. But if he is content to go on as is, and defer the inevitable for as long as possible, that is great!

Of course I think we all hope for a peaceful, non-suffering death, and a happy contentment up until that moment. If only, huh?

Again, thanks to all. Every comment is helpful to the discussion I will have next week with my Da.
SheBee

I could be wrong on this

by jane32 - 2012-05-18 01:05:00

but I understand that pm,s only help slow heart rates, that they can not help fast rates. It something for you to look into.

Regards Jane

fast heart rates & 80,90+ yr olds

by SheBee - 2012-05-18 01:05:28

Still haven't had the talk with Dad's doc, but I think from what my brother has told me, that they somehow shut down the sinus node that amazing cluster of cells at the top of the heart taht generates the electrical impulses that regulate the heart beat. So they implant the PM, then turn off his natural organic pm, so that only the mechanical one is sending impusles.

Jane your moms situation may better correlate to my dad's i probalby worry about the dementia the most.
Another thing is that last year, while my mother was in hospice, my Dad & I visited an aunt in an assisted living home, where most residents are are very active, I asked him if he'd ever want to live in a place like that and he without hesitation said NO, that he liked his privacy and solitude. I think he really wants to die in his sleep at home...he stopped using his oxygen at night shortly after my mom died, said he didn't notice any difference, but when his tachycardia started his doc convinced him to resume it.

I am very impressed with your friends 103 yr old mom!

Again, thank you all. Great comments & good advice. Great reminder to enjoy my Da!. I am going to focus more on that and less on the big decision!

Hi Sheebee

by jane32 - 2012-05-18 01:05:48

I rang my friend about her 102 year old mum, and she said her mum got her pm when she was about 99. She had a low heart rate, she has always been very active, and only moved into a rest home this year, she is almost 103. Her daughter says she still goes for a walk with her pusher around the corridors of the rest home after a meal. She also said it has given her a better quality of life. Its a very hard decision for your Dad to make, but one worth looking into. I can understand your concern as my mum spent the last 4 years of her life in a rest home suffering from dementia. She also was very deaf which left her a bit isolated even in company. When we were asked did we want her recusitated, if she needed it, we said no as we know that she wouldn't have wanted to. We were lucky that mum did remember us until almost the end, and she had a lot of good times in the rest home, even though she forgot them quickly. She was 92 when she died. I'm not sure if this is of any help, but just enjoy your dad whatever decision he makes, he is lucky to have you as you are to have him.
Cheers Jane

My mum always told us

by jane32 - 2012-05-18 08:05:28

that if we put her in a rest home she would come back and haunt us. (which she hasn't done) There was no way she would have chosen to go into one, but when she become unsafe in her own home we had to make that decision for her. They had so many activities in the rest home that she really enjoyed, they held a ball every second year so she was able to enjoy getting dressed up in her finery. By the time she was tucked up in bed that night she would have forgotten she had been, but we just lived for the now with her. We also had plenty of laughs, one time being my sister in law and I took Mum swimming, they have a pool in the complex, we spent about an hour in pool, took her back to her room and dressed her. She went to the toilet and came out and was most surprised to see us. In that short time she had forgotten we were there. We didn't let that worry us. If you don't laugh you would cry.

cheers Jane

Sheebee

by ElectricFrank - 2012-05-18 12:05:54

Thanks for the feedback on my post. I'm happy your dad has you to be with during his final times.

frank.

PM for octo & nonagenarians UPDATE

by SheBee - 2012-06-01 09:06:35

Just wanted to share with you all that last week we gave my nearly 92 yr old dad a list questions he might want to ask his doctor about the pacemaker they wanted him to get to control his tachycardia, along with a piece I wrote (culled from things I have read about questions to ask doctors, my own experiences with doctors, my own and others medical treatments, and my own thoughts), titled "Being In Charge of My Health & Medical Treatments," in which ones rights are emphasized, along with the 1 page abstract of the Mayo Clinic study. Within a few minutes of reading them these, my Dad very clearly stated that he didn't want the pacemaker and had no concerns about living much longer.

He's a man of few words. I think what we gave him to read empowered him to be clear in his own mind and reinforce his own first reaction to the idea of being implanted with a pacemaker, which was that he didn't want it. He was swayed by my brothers first reactions, which were influenced by the cardiologist,that it might save him ER trips. I think Dad thought if his son thought it was best that was what he should do. We all agreed to put the decision back in his court without saying one way or another what we thougtht he should do realizing we didn't know what would be best for him.

This past Tuesday Dad told his primary family doctor, that he didn't want the PM and was also going to stop taking his medications (he's already stopped using the oxygen he was prescribed to use at night). His doc ascertained that Dad was lucid and of sound mind, and then said it was a good choice, and one he agreed with and told Dad that he would inform the cardiologist, who as my brother described him is more of a technician than a healer.

We have no idea, nor does the doc, how long Dad with survive with his tachycardia...the man is strong, a farm raised WWII Air Force vet, recovering alcoholic of 28 yrs and a "retired" peace activist. He could last a long time. The doc says he will just get more & more tired and eventually expire. He may have a stroke first, but without any medical intervention, which is his will, he won't likely live very long after one. He is adamant that he doesn't want to be in a nursing home.

I am sad but proud of him. I also wonder if he might actually get better after a while of not taking the medications. I will keep you posted in gratitude for all your wise advice and personal shares. Shebee

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