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My husband has Alzheimer's (4 years since diagnosis) with severe cognitive decline. He had tests after a mild stroke this summer and might need a heart pacemaker. His doctor says his heart arrythmia is not life threatening but he might get dizzy and fall and hurt himself. She (doctor) said that if my husband was in a care home she would not recommend a pacemaker, but since I am trying to keep him at home with best possible quality of life he should get the pacemaker (pending results of further tests) to prevent a serious fall. Before his Alzheimer's became severe, my husband and I discussed whether we wanted life-extending interventions and he did not. My son says it is my decision. My youngest (a daughter) wants everything medically possible to keep him alive as long as possible. Has anyone else faced this issue? I have seen in the internet that pacemaker in this situation is a controversy.

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My Dad has dementia, pacemaker and parkinsons. Pacemaker is the newest addition for slow heart beat. He has fallen many times before and after the pacemaker. He is living at home with caregivers and spouse. The problem was more related to body weakness in the legs, in activity of sitting in recliner all day, irregular BP did not help caregivers who did not stay with him all were part of the falling problem. Get a second opinion if you think that will help you.
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Reply to medicaidmaze20
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Imho, his specialists (neurologist and cardiologist) are the best ones to give an answer to this question. Prayers sent.
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Reply to Llamalover47
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Ruth, Pacer most often given for SLOW rhythms and for someone who has to take medications that will/may slow the heart rate. If there is none of this I fail to see how a pacemaker would help; ask your heart doctor about that. Would be so interested in how he would think a pacemaker prevents falls.
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Reply to AlvaDeer
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People fall, even in care settings. In a care setting they have staff to scoop up the fallen and hopefully have trained people to evaluate if a trip to the hospital is prudent. And hopefully a care setting is designed to prevent falls with handrails and lack of things to trip on. It seems like a good time to evaluate how much of those things can you mimic at home. Which might help inform your decision.
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Reply to LauraDangel
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I sympathize with your situation. You want to keep your husband comfortable and safe while he is alive. Your family members have conflicting advise - most do. So put aside their wishes, desires and motivations. Think about those conversations your had with your hubby before his cognitive decline. What types of treatments did he think were reasonable: machine-assisted breathing devices, insertion of tubes for nutrition and/or fluids, CPR and other life saving options. and lastly any device that would "extend life"? When you consider those conversations, you will have your answer... since you know his heart and mind the best.

Choosing a pace-maker, or not, is more or less about extending his life. With a pacemaker, he will have less dizziness and possibly more energy. A pacemaker will not guarantee that he will not have a serious fall - there are a lot more factors that attribute to falls than heart rate and blood pressure. He will need to be able to stay in the hospital for the procedure and while they monitor his recovery and possibly for a few days until his pacemaker is calibrated correctly for his needs. He will need to be able to leave his surgical site and dressings intact, not disturb his IVs or urinary catheter, and deal with the unfamiliar surroundings and protocols of the hospital. Only you know if he can realistically deal with these issues or will need to have a paid sitter with him 24/7. Consider how he manages with changes in his routine at home as a guide to how well he will deal with this major change in a hospital.
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Reply to Taarna
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Thank you all for your very helpful replies. My husband wore a Holter monitor in hospital after his mild stroke. That was the basis for diagnosing intermittent arrhythmia. He has never had a fall!! Thats why Family doctor telling me husband might need a pacemaker to “prevent falls” is worrying. I will get the results of the stress test this week. Hopefully normal then pacemaker a non issue.
much appreciate your replies
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Reply to Ruth75
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How old is your husband and how far along is his dementia? Doctor stated that if he was in a care facility they would not suggest going thru with the procedure. How much longer do you think he will be able to remain at home recieving care before needing to be moved for his safety and wellbeing? We went thru a similar situation with MIL, older child wanted valve replacement and pacemaker for her mom, meds were "just a bandaid " for her heart. MIL was 90 with chf/afib and could not be anesthetized, not a candidate for invasive surgery. Thank goodness cardiologist and my husband were on the same page and he was medical poa if needed, ultimately it was her choice not to go thru with the surgery. You said that he did not want to have any life extending medical interventions, making his decision while still being able to. As hard as this is for you, respect his choice. As others have said get a second opinion and testing done. Would it help to speak with your daughter and advocate for her father's choices, having someone there to explain this devastating path that alzheimers patients go thru and having the surgery may not be the kindest thing for HIM? It's only natural to grasp at straws and to want to fix the problem but we need to ask at what cost to the patient, ie prolonging a journey of decline for them. This is one of the reasons we sat down with our children so there were no misunderstandings and also put it in writing. They both have a copy of dnr/end of life choices. Has she been involved in his care on a consistent basis witnessing his decline or is she in denial about the situation, thinking he's fine, or not that bad? I am so sorry you are going thru this, caring for LO is not an easy road traveled. Before he returns home speak to the hospital social worker, he may be eligible for hospice or palliative care services in home because of his chronic heart condition. They will continue meds but will not seek a cure for it. Keep us updated on how things are. You have this forum for support, or just a place to vent when you need to. Prayers for you and your family.
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Reply to Takincare
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No
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Reply to XenaJada
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I would get a consult with two cardiologists before I did this. First of all, most falls have little to do with any change in heart rhythms. They may have to do with low blood pressure, which may be due to medications used to treat heart rhytyms. Many heart arrythmias are due to atrial fibrillation, which is often treated with beta blockers and other medications which, as a side effect, lower the heart rate and the blood pressure, leading to more falls in someone elderly and with already having balance issues.
I am not certain what changes they hope a pacemaker will be. Has your husband worn a holter monitor to see how his heart rate acts during the day? Does he get up slowly to adjust for blood pressure changes when raising out of bed or chair?
In general pacemaker surgery is without complications usually, and the person is not fully anesthesized to get a pacemaker. Batteries now last upwards of 10 years. But I seriously question whether these falls are due to any heart rate problems? I am not seeing the connection unless they explain it to you more fully. I would be certain they explained the connection they think is there completely and to your understanding.
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Reply to AlvaDeer
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cwillie Sep 27, 2020
When my uncle was momentarily blacking out and having many falls he was skeptical of the advice to get a pacemaker but he hasn't had any episodes since, so there can be a connection.
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