97 year old father - pacemaker needed?

They want to put a pacemaker in my 97 year old father. He has moderate dementia. He has no other illnesses but a-fib with "tachy-brady syndrome". They've done a fair job of controlling his heart rate with meds but he still ends up in the hospital periodically with tachycadia and he's had one observed episode of passing out and other probable episodes where all we saw were the bruises. Everyone agrees that the primary issue for him is quality of life. If he would be less likely to pass out, fall or end up in the hospital that would be nice.

But he's 97 and demented so the family is wondering how far to go, how risky the procedure is, how much discomfort he'll be in, etc.

Any thoughts would be greatly appreciated.

11 Comments

Philget.....................

by Tattoo Man - 2013-02-28 04:02:05


............................you ask a simple question,..born of a very complex run up.

Your own words.."Quality of Life"...just how do you define that ,,?

PMC knows, but a glimpse of how you and your father are.......

What / Can ..you get from Dad.......its about Life,.. and its His..what does HE want ??

"Passing out..Falling over..Hospital"

Sorry, just questions, ..but , sorry to be so challenging..

...it has so much about how you look back on this period..tomorow ..next month ..next year.

As in all lifes big decicions....make a choice and never doubt your choice,when looking back...you did your best..and that is all you can ever do..

And its probably what Dad would have told you...

Tattoo Man

As ever keep PMC informed...its how this wonderful group of people have the knowledge to further stuff / knowledge / opinion / ...to ..19 .000, and more people

fkwgd

pacing

by Tracey_E - 2013-02-28 04:02:21

The surgery is low risk and fairly easy recovery, as surgeries go but it's still a surgery with some amount of risk and recovery time. My question would be how low is his heart getting during the brady episodes? If that's what's causing the passing out, then yes, a pm will help him. If tachy episodes are what is landing him in the hospital, the pm won't do anything for that. If the heart goes fast on its own, all the pm will do is watch. It can only add beats, it can't prevent the heart from beating on its own.

If his heart is getting dangerously fast, they may want to do an icd instead of a pm, it paces but also has a built in defibrillator to shock the heart out of dangerously rhythms.

Have they done a Holter monitor to see exactly what his heart is doing? How fast the tachy is, how slow the brady is. If he hasn't had that, then that's where I would start.

Getting A PM

by J.B. - 2013-02-28 04:02:47

Good God Almighty, a simple question about what a pacemaker may do for her 97 year old dad and she should now be totally confused by the answers she has gotten. My recommendation is that she use all theses wonderful comments to make her a list of questions and talk to his doctor.

Prayers

by ebfox - 2013-02-28 05:02:56


You need to read the following article

http://www.nytimes.com/2010/06/20/magazine/20pacemaker-t.html?pagewanted=all&_r=0

You will have to cut and paste that into your browser. It is a NY Times article entitle "A Pacemaker Wrecks a Family- What Broke My Father's Heart" It is very pertinent to your current decision.

My thoughts and prayers are for you and your father.

EB

dementia question

by SaraTB - 2013-02-28 06:02:12

Does your father understand what's being proposed? My mother had dementia. Dementia patients typically don't do well with surgery, depending on how bad they are: anaesthesia sometimes affects them adversely, resulting in a further deterioration of their cognitive level. If they suffer from agitation, they may find the whole process and hospitalisation distressing, which again may have a detrimental effect.
Further, you say his hospitalisations have been for tachycardic incidents? As I understand it, a pacemaker will not help this, only the bradycardia.

I think the whole issue of your father's dementia is being overlooked in this discussion, yet Quality of Life is being brought up. Please, please, ask his doctors to honestly assess the possible effects on his cognitive abilities. Ask them to tell you honestly, if this were their father, what they would do. I would really, really be reluctant to put him through the surgery if it were my parent.

My heart goes out to you and your family, being faced with this decision and managing your father's condition.

If it were me I.......

by dad4dds - 2013-02-28 11:02:34

would not want a pacer at 97. Praying for you and your family.

May Get A PM

by SMITTY - 2013-02-28 12:02:32

Hello Philget,

If the passing out is due to low heart rate, then a pacemaker will most likely be a big help for him. It will have a low set point of whatever the dr determines is best for him. Mine is 80 and many people have 60 or less. The PM will not let his heart rate go below that set point and should stop the passing out. As for the surgery so far as I think there is little or no risk.

To give you an idea of what is involved for me with the surgery I am including something to give you an idea of what the surgery involves. Your father is 13 years older than me so his may be a little different. Once you gets the PM it requires no, or very little, attention.

The following may give you an idea and relieve some anxiety about PM surgeries for your Dad. I got my first PM in 2000 and the 2nd one in 2009. Both were done in the same hospital but by different Drs. Both surgeries were almost identical. So to give you some idea of what you are facing:

On arrival at the hospital I was given a some of the hospitals latest fashions to put on and told to lie down and get comfortable as it would be a little while before the surgery. I read the paper and watched TV for a couple of hours while other PM patients were also being readied for their PM . After about an hour I got an IV and spent the next 3 or 4 hours being "prepped" which consisted mainly of getting about a quart (at least it looked like that amount) of antibiotic through the IV and the surgery area cleaned and cleaned real good.

About noon the doctor showed up and examined the area for the implant. After another hour or so I was wheeled off to the surgery area where I spent another 30 or 40 minutes being "dressed or draped" for the surgery. Sometime after I got in the surgery area I received some medication to make me relax so they said, but what it did was make take a nap in about a half-sleep mode. I vaguely remember being told they were injecting a local anesthetic into the area where the surgery would be performed so I would not feel the anything. About 45 minutes later I was told, "okay Mr. Smith, we are through and your pacemaker is working just fine." I was wheeled back into a room where I had to wait for awhile to be sure I had no adverse reactions to any of the meds I had received. About 5 PM I was told I could go home.

I was not unexpectedly sore and my healing was no problem. I did have restricted use of my arm for a few days, the main thing being not to raise my elbow above my shoulder, or lift more than a few lbs. Each of us is different, therefore get slightly different instructions) with the arm on the side of the PM. I was n lot allowed to drive for about 24 hours and then for short distances for a week or so. All in all the pain is less than most dental surgery I have had, and since I was retired even with the first one, it did not interfere with any activates.


One last word, you will go home with your Drs best guess on PM settings. Most of the time these are good, but occasionally some people need to have those settings tweaked. If you think your PM is causing you a problem, if it is just that you think something is amiss, let your Dr know, otherwise he will have no way of know everything is not perfect.

Good Luck to your Father,

Smitty

Easy, but

by ElectricFrank - 2013-03-01 02:03:57

This is one of those questions that modern medicine is throwing at us without any help.

The logical answer is to forget the pacemaker and other life extending activities. His life is rapidly becoming over with only a body hanging around for a while.

Then there is the emotional aspect which few of us are equipped to deal with. It's the one thing that our educational system doesn't teach. The conclusions we reach emotionally is based on our being unwilling to face our feelings about losing a loved one.

So it is impossible to suggest a course of action in such situations because it totally depends on the feelings of the family, and rarely on the feelings of the person involved.

At 83 yrs and alone I am very aware of the possibilities of my future. I have made the decision that I will bring my life to an end before putting myself under someone else's control. I would rather err on the side of too soon than too late.

frank

Wow

by pacergirl - 2013-03-01 09:03:16

Uhmmmm I myself would not do this to my Dad or Mom or to myself. But, you have to decide for yourself. 97 is an very nice long life. Praying you find the wisdom you are seeking.

Re my 97 year old father - thanks

by philget - 2013-03-03 02:03:07

Thank you all for your time and thoughts. I got my father's opinion as best I could given his cognitive limitations. One thing he was very clear about: He was willing to do anything that might lead to fewer trips to the hospital. I thought about who he was and is: a WWII pilot, then a test pilot - never one to shrink from taking a risk. So as his proxy I made a call: The pacemaker was installed yesterday. The procedure was quick, under an hour, and was done under the lightest sedation the doctor could manage. Dad seemed fully clear a few hours later, eating, talking, without any mental deterioration that I could see. So far he hasn't complained of pain. They've given him Tylenol and Advil just in case but no narcotics. Hopefully, they'll now be able to control his tachycardia without worrying about throwing him into bradycardia. I read the NY Times article recommended by ebfox. What a great article about our broken health care system and unnecessary prolongation of life. I handed out copies to all 3 of his docs (including the one that did the procedure) and a couple of nurses. But Dad's issue was quality of life, not quantity. Hopefully, that'll be improved. Thanks again.

great!

by Tracey_E - 2013-03-04 03:03:09

So glad to hear it went well!! Sounds like it was the right thing to do. Prayers the tachy can be brought under control quickly.

My grandpa is also a WWII vet and I think cut from the same mold as your dad. Grandpa got both knees replaced last year at age 91. Now, he's back to working his land and rebuilding his vintage cars (and not driving my grandma crazy because he's in too much pain to be active). Age is just a number sometimes.

You know you're wired when...

Your kids call you Cyborg.

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