95 year old Mom

My 95 year old Mom (I am her POA and caregiver) has a pacemaker ( the shocking portion has been turned off).  Her battery is good for another 6 months and she doesn't want to have a new battery.  I am reading with interest the comments about end of life and wondering how to make accommodations for her.  Wondering if I shoudl bring her home with me.  I undesrstand that she would revert back to her "natural" heartbeat when the battery dies but jsut wondering what to expect.  Any advice is appreciated.  Thank you.


8 Comments

95

by Gotrhythm - 2019-10-05 17:53:33

Contact Hospice. You don't have to wait. They have experience with pacemakers and will be able to help you and your mom right now, so that your mom can have the best quality of life possible. You will probably need to have your mom's doctor refer her.

With Hospice's help, you will probably be able to keep her at home, and they will also help you with respite care when you need it.

I reserve the right to change my mind, but as of now, I've decided that when this battery dies I won't replace it.

Here's what I understand. As the battery winds down, there will come a point at which the pacemaker will shut down all the fancy settings, and revert to the default setting of just a steady 60 beats per minute.

Most people do not feel well when that happens--and that's where Hospice can do a lot to give palliative care and also to support you. There are medicines that can help with the feeling of breathlessness, and the restess anxiety that can go with it. Drugs to control chest pain, if any.

Do be aware that many states put pacemakers in the same category as artificial life support, like respirators, and as such have made it both legal and ethical for medical personnel to turn off a pacemaker at the request of a patient. It doesn't have to be "removed." It's turned off with the same equipment that checks it.

I honor you for being willing to support your mother's wishes. It's not easy but it's a great act of love.

 

Thank you!

by lakegirllynnie - 2019-10-05 18:25:13

Thanks to you for your thoughtful comments.  I have experience with Hospice and agree that's a good idea.  Will talk with the doctor about this in early December.  thank you-- Lynn

95

by ROBO Pop - 2019-10-06 04:56:01

Good for her, she's lived a long life.

In the US, Turning off pacemaker function is dependent on three things you can easily check.

1. Is it legal in your state. Here in AZ a patients pacing function cannot be turned off if they are pacer dependent. Ask her Cardiologist to be certain. I am 100% paced in both ventricles but not dependent. Now, if she has a defibrillator, that function can be turned off and in fact I had mine switched off. Still paced though so recognize the distinction.

2. Again, in some locations in the US a POA (Power Of Attorney) isn't a valid document for some legal and medical purposes. We had one for our aunt and had to hire an attorney to get additional court documents to handle her affairs.

3. Ok, somebody help me out here, what was my 3rd point?

Well it'll come to me. At any rate I agree with gotrhythm, get her set up up hospice care, it can really help under difficult conditions.

Oh I think #3 was make sure you talk to her doctor and know the good, bad, and ugly of this type death. It can be difficult for both the patient and family.

Good luck to you both

Age and quality of life, consent, and mental capacity.

by Selwyn - 2019-10-06 08:14:12

I am always concerned when age is mentioned. Here in the UK we have had a number of cases where the High Court has instructed doctors as to whether life support can be ended in the young ( This week we have doctors wanting to end life support of a toddler, and the Court deciding the parents can move the child to Italy for care. )  however, to my knowledge, there has not been a court case re. the elderly, though there is plenty of advice. ( see later) I myself used to carry our mental state examination under the Mental Capacity Act 2005 (UK) as to the person's ability to consent.

Surely, what is important is the quality of life? We have a few 90+ persons doing ballroom dancing with us. The oldest member of my table tennis club is over 90. My Mother-in-law has severe dementia ( aged 85), yet she has a pacemaker, implanted to offset a slow heart beat from the drug she takes for dementia ( now discontinued as her dementia is so severe and she had some side effects)  and she is not suffering or distressed with her dementia. There is no reason to remove her pacemaker. 

Death with a pacemaker functioning, is death. A pacemaker is not going to prolong organ failure, rather it is a matter of quality of life. 

The UK does not have a law permitting the ending of life artificially. Of course, no one wants to be a burden (I belive cost in the USA can be a problem) , no one wants to be depressed, and no one wants a nasty end to their life. Whilst consent is one factor to consider ( "Please end my life doctor'!), quality of life issues dominate ( "Please ease my suffering doctor"!). Some folk have strong religious views about the sanctity of life.

There are an increasing number of pacemakers fitted to the over 90s.  This improves their quality of life, prevents accidents, and may improve their mental well being. Without the will to live, many elderly people will give up and die. The importance of well being cannot be over emphasised and there is a great read in, ' Man's Search for Meaning', a 1946 book by Viktor Frankl, concerning the will to live. 

Anyone interested in the debate may wish to read the discussion within

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1768089/

Ultimately, some decisions are taken that turn out to be harder to live with for those remaining behind. I have seen many people change their minds after further considerations ( eg. prior to amputations, prior to other major surgery, after suicide attempts-depression etc.) I cannot over emphasise the importance of good end of life care. A decision to end life by an individual needs their concerns to be explored. No one should be distressed at the thought of their dying from their natural, given, life-span. 

I have enjoyed many 100+ year old birthday parties with those reaching that age. There is still some pleasure to be had in receiving a centenarian birthday card (with its little red tassle)  from The Queen who is herself 93 years old. One of my lasting memories is at a 100th birthday, of  a lady in a nursing home, smiling whilst eating chocolate buttons. I only wish I had sent a video of her to the manufactures... after a 100 years of life, the sheer pleasure...

It's a huge responsibility

by crustyg - 2019-10-06 17:36:36

And I salute you.  Having watched, and sat with, many patients at the end, I remember the emotional burden, and I wasn't related to any of them. And some loved ones too.

Here in the UK, to listen to some folk, you'd think we'd never passed the 1961 Suicide Act which finally removed the historical sin derived from Canon Law and stopped persecuting the sad and unfortunate folk who had attempted to end it all for themselves, for whatever reason.  But we still hound those who do what is required to ease the passing of a loved one.

Viktor Frankl's Recollections was also an amazing book, from the man who founded the Third Viennese School of Psychotherapy, who had lived in man's hell and helped others in the camps to find a reason to continue -  an intensely personal decision.

Home is where I think we would all like to be when the end is near.

thanks to you all

by lakegirllynnie - 2019-10-06 22:15:09

My Mom's quality of life has slipped away from her and she has expressed her desire "to go."  I appreciate all of your comments and support.  I can only hope that her transition is peaceful and stress free.

 

Thanks again to you all.

Going back to your original question

by Gotrhythm - 2019-10-08 16:34:37

I fear the group wandered off-topic and didn't really address your question i.e. what to expect.

You said, "I understand that she would revert back to her natural heartbeat when the battery dies, and I was just wondering what to expect."

Because I do not wish to replace my pacemaker when this one gives out, I have had similar questions and have researched the subject, combing the internet for authoritative sources.

Here's what I have learned.

Every time a pacemaker is interrogated, a test is run to see if the heart still has an intrinsic beat. 

If the heart still has an intrinsic (native) rhythm, then yes, it can continue even when the heart is no longer being paced. A person will not not neccessirarily die the very instant the pacemaker stops.

However, you must remember that in most cases, the pacemaker was implanted because the native heartbeat was too slow. So whatever rhythm still exists isn't fast enough to keep the blood pressure up, or the body supplied with enough oxygen to sustain life, for any length of time.

Once artificial pacing stops, the blood pressure will fall and unconsiousness will ensue very quickly. Eventually, as the brain is starved of oxygen, death will occur.

How long? A report compiled from Hospice nurses' observations, indicated the time might vary from a day, or less, to thirty days. 

As you can surmise, providing comfort care will matter most during the period when the pacemaker is still functioning, but only minimally. 

A word about having six months of battery left. That's only an estimate. Factors that determine battery life are too variable to predict exactly when the battery will fail. The time  could easily be longer or shorter.

Hope this helps.

Glad to know you are familiar with the services of Hospice, and will seek them out. They are willling to make their whole focus quality of life rather than extending life. They are very familiar with pacemakers at the end of life.

Bless you. Let us know if we can help.

 

 

Pacemakers and the end of life

by Rivithead - 2019-10-18 03:36:36

Does anyone know if one's PM can be donated to an animal hospital when one dies?  Must be some ol' doggies out there that might be able to use it.

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