My aunt lives in a Nursing Home. She has moments of confusion but she has expressed hating her situation. She has no children and I am one of her closest relative but I live in another state. She was admitted for CHF last night and I was told she is a candidate for a pacemaker. She has expressed to me that she is “just waiting to go”. A pacemaker might reduce symptoms of CHF, but it is associated with a 45% chance of a 5 year survival, which means I am potentially signing off on prolonging her life in the nursing home. Is hospice/palliative care adequate at keeping her comfortable?
My mother at age 94 had very little quality of life, mobility and toileting issues. She was a shut in and had not left the house except for doctors appointments. When She was unconscious in the hospital after a cardiac episode my father gave authorization for her to receive a pacemaker.
It really did nothing to improve her situation. She still is not mobile and cannot toilet herself and is very depressed. sShe can linger like this indefinitely because she has no other life threatening health problems.
She was home when she received the pacemaker. She is in a NH now and can be there for years because of this thing.
So based on my experience I wouldn’t do it. It is not humane.
I’d be scared too getting a pacemaker..
I'm sure it's hard to make that kind of decision on your own.
Best of luck to you
True stories lady in her late 90s ( 98), had a medical setback. The priest came to talk to her, she said she was ready to go, and so she did on Christmas night.
Another one bedbound male resident in a room no window to see storms, sun, snow, just a darkened corner of the room. He definitely was ready to go ( and did) because he ate what he wanted and really had given up. Both residents are at peace.
The pacemaker did not cure her CHF, nor did it extend her life. When she went onto hospice, we had the defibrillator part of the pacemaker deactivated - a very easy, non-invasive, procedure done in her cardiologist's office.
When she had the procedure, they used very (and I do mean very) light anesthesia - she said she was awake for the entire thing but numbed so she felt nothing.
You should have a conversation with whichever doctor is recommending this - both the pros and the cons of the procedure, as well as what death will "look like" when she gets to that point.
I was in favor of her having the procedure done, simply because of her increased risk of stroke, and the possible complications that would arise from it should it have happened and she survived it.
I do not personally see how they feel that a pacemaker would help her CHF overmuch. CHF is basically heart failure-- left, right or both. So I would ask for all of that to be drawn out for me in great detail. As in "Could you be very specific for me the ways in which you feel a pacemaker would help my Aunts Congestive heart failure".
Other than a heart transplant or valve surgery, there's no cure for a failing heart. Usually the treatment is diuretics to keep fluid off the lungs and the peripheral areas. Often measurements of labs are required because these diuretics wash out electrolytes along with fluids, so they are sometimes not given in Hospice situation.
I personally would choose palliative and hospice care. You MAY be prolonging life. You may not be. Pacers work on the "electro-mechanical systems" of the heart if you will; they trigger heart beats, are set to slow or regulate heart beats, are sometimes used to maintain heartbeats at a certain level when medications that lower rates are used in increasing dosages.
You might consider doing a bit of your own research. Look up "pacemaker for congestive heart failure" and so on.
You know your Aunt's wishes better than we do, hopefully. And from what you say I would be doing no procedures that could prolong life.
Last year they offered to put a pacemaker in my FIL for bradycardia to help control CHF . It wasn’t going to buy him that much time so he declined . He had so many other issues as well .No point in prolonging his suffering .
Be very sure the pacemaker has benefits that outweigh your concerns, know the fluid build up is inevitable, know to shop hospice agencies if that is what you choose as they are not all equal, and know that she can be kept comfortable as the meds of hospice are compassionate and effective. I wish you both peace
You really don't want her getting anesthesia either. It could make her cognitive decline worse. Me, I would rather have my mind longer. The discomfort afterwards and the poking and proding.
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