I've been asked to consider not replacing my Aunt's pacemaker because she has a DNR. Has anyone else faced this? - AgingCare.com

I've been asked to consider not replacing my Aunt's pacemaker because she has a DNR. Has anyone else faced this?

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My Aunt is 95, in stable health, with some dementia and memory loss. She requires a companion (private pay) because of advanced macular degeneration and memory problems. She is also in an assisted living facility so she has checks at night and medication management.
She has had her pacemaker ten years and it needs a new battery. The cardiac unit at the hospital called me and asked me to consider not changing the battery.
They told me to talk with her doctor and the other family members to decide.
She is not pacemaker dependent, but I was told her pacemaker helps correct the electrical signal to the heart one or two times per 100 beats. They expect falls and possibly injuries from no pacemaker.
Basically, they provided a life sustaining treatment that they now want me to consider removing it. How does anyone make this decision? I love my Aunt. I enjoy my Aunt. She is loving, caring and cracks jokes constantly. Her caregivers are loyal and loving and go to work to have fun! They laugh all day and love on my aunt as if she were theirs. She visits with other residents where she lives and participates in music and scenic drives. She also has pain from a hip replacement that has gone bad, and is in a wheelchair except in her room. She is frustrated because she can't remember why she can't see. She has expressed not wanting to live, then almost instantly shifts to humor and wants to go do something. She confided to me five years ago that she wasn't sure she made the right decision to get the pacemaker. But she was independent and living at home at the time and I remember she didn't give it a second thought. I am guardian, health care power of atty and durable power of atty. I have been closely involved with her for the last six years taking care of every aspect of her care and financial matters. There is plenty of money, but it's disappearing fast. I feel that my decision will cause her pain either way I go. Prolong a life with immediate, present small joys and pain, or authorize the possibility of injury and death which goes against every fiber of my being. Does anyone have any wisdom, experience or advice? Thank you.

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Having been thru this for the last 7 years with my mother, I would recommend allowing her to have a natural death. My mother's pacemaker was replaced at age 97. She is now 103, no longer able to do almost anything for herself. Her age related dementia leaves her confused in time and place. I can't express in a few short words how sorry I am that I allowed the dr to replace her pacemaker. And now he refuses to turn it off. You, the caretaker, will think you can't take another event, then you get another call. We are born, we live, and it is very normal to die. It is the normal way of life, trying to make it last forever is not normal.
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Also, a DNR only means do not resuscitate if the person quits breathing or heart stops.
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Having been thru this for the last 7 years with my mother, I would recommend allowing her to have a natural death. My mother's pacemaker was replaced at age 97. She is now 103, no longer able to do almost anything for herself. Her age related dementia leaves her confused in time and place. I can't express in a few short words how sorry I am that I allowed the dr to replace her pacemaker. And now he refuses to turn it off. You, the caretaker, will think you can't take another event, then you get another call. We are born, we live, and it is very normal to die. It is the normal way of life, trying to make it last forever is not normal.
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The dnr is often used as an excuse to not only not do cpr but to not do anything. It is really abused these days
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Jeannegibbs is correct, a pacemaker will not start a stopped heart, a pacemaker regulates the heart rhythm, but it needs replacing every so often. If it's not working properly, the battery has died then it won't do the job it was intended to do. Your aunt will have an arrhythmia that could lead to death. This would be questions to ask her physician
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MadisonMike, that is not how a pacemaker works. My husband died with a pacemaker. It did not need to be removed or stopped. A pacemaker keeps the heartbeat regular. It does not revive a stopped heart.
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End of life decisions can be difficult and everyone has different opinions and beliefs. What does your aunt say about battery replacement? She may not want this extra measure. You must know that making such a decision is not always easy. I look at quality of life. Is there quality there? What are the risks of the surgery? What does her primary care physician say about battery replacement? Given your aunts age, her dementia and her functional level, she may do well with a battery replacement, but does she want it? Making such decisions are very personal, it sounds like your aunt is able to still enjoy some things life has to offer, but what will happen if her health declines? What do her advance directives say? If she's a DNR, then she probably doesn't want 'heroic' measures to save her for a life of misery. Ask her physician is a pacemaker/battery replacement is a heroic measure.
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My understanding about a DNR and a pacemaker is that with a pacemaker even at death it will continue to do it's job ( to stimulat the Hart). To me this looks like a form of resuscitation and even though there is the DNR this continuation of stimulation over rides it. If there is a passing with the pacemaker still working at that moment of death you would have to do what is equal to pulling the plug, have the pacemaker removed at death and would a doctor / hospital do that.
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Twin, I'm truly astounded that Aunt's NH thinks that way. We ended up agonizing over a pacemaker last summer for my 91 year old mom who has vascular dementia from a stroke and had survived surgery for a broken hip. She's had a DNR and DNA for years. Her heart's electrical activity dropped and couldn't be brought back up to normal range ( it's called heart block, I believe) after a fall. We were clearly told by everyone we spoke to at the hospital that it is not considered an extraordinary measure by anyone anymore. We presented the idea to mom who said that she wanted it. When she was readmitted to her NH, they were like, of course you did the pacemaker, why wouldn't you? Just wanted to share that with you, I believe you are making a good decision.
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Honestly - I think your facility is wrong to try to limit your choices like that. We may not want burdensome or invasive treatments and certainly don't want futile treatments, but it may not be our goal to just get things over with as quickly as possible either. I faced that in hospice where they did not want to give my mom her Sinemet and were just going to do phenergan and a narcotic around the clock and I had to insist we were not going to do it that way. Sinemet allowed her to swallow and feed herself and not have so much tremor, and we wanted to have some grandkid time for her, and make a few more memories if we could. Plans should not be so cut and dried, "violation" and "permitted" just seem like the wrong words. I can see forgoing potentially curative treatment for cancer, with all the attendant medical issues and side effects being required to be on hospice, but not just normal maintenance for a pacemaker! And now that I am thinking about it a DNR does not = hospice. I have heard of facilities that require DNR as a condition for residing there, and I really think that is wrong enough to change facilities if they can't let you temporarily rescind the DNR just for the surgery. I don't mean to put pressure on you or your aunt in a tough situation, that's just my $0.02 and what makes sense to me. Sorry you are going through such a hassle!
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