So yesterday, Mom, almost 91, CHF, one year post stroke, vascular dementia, some aphasia, broken hip repaired 6 months ago, fell in NH. She thinks she fell out of her wheelchair while trying to stand up with her walker, thinks she didn't put one of the brakes on, no way to tell, no one witnessed fall. She vomits after she falls and NH calls 911; EMTs find she's got a rather low heart rate and decide to transport her to hospital. Turns out she dehydrated; heart rate drops to 37 and stays there. We discover today she has "total heart block"; upper and lower chambers are no longer communicating with each other. There seem to be two choices; leave her be, which means letting nature take its course and death is inevitable, or putting in a temporary pacemaker today, replaced by a permanent one on Monday. As we are talking with the doctor, test results indicate that her kidneys are starting to shut down due to lack of perfusion due to heart problem. Brother and I have a long talk (he is POA). We present situation to Mom--your heart is having problems beating on its own; they want to put in a pacemaker; would you like them to do that? There is some risk, but if we don't do it, the prognosis is not good. She says, she wants the pacemaker. We explain that it means two days in ICU, probably restrained at night so she doesn't pull out the lead. She closes her eyes and thinks and opens them and says "yes". We probe, she gets out, yes, I want it. So, Mom has a pacemaker! I will let you know how the permanent placement goes; what I'm most worried about right now is mom developing ICU psychosis--from isolation, from being restrained, being in an unfamiliar place. If anyone has other experiences or advice to give, please let me know. Also, in talking to the doctor, I found out that if dementia worsens, etc, we can turn pacemaker off. That really tipped the decision for me.