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Good evening All. My 93 yr old mother has decided not to get a new pace maker put in. The battery on her old PM is almost 10 yrs old and is running low. The life span of a PM battery is usually 10 yrs. She is on hospice now for 4 months for end stage congestive heart failure. She is still of sound mind, and it is her wish not to get a new PM. This is a new stage of my caretaking with her. I have been her caretaker for 8 yrs now, and up until a year ago, she was still fairly independent within her home. I believe her battery is running very low as they have a difficult time getting a reading on her blood pressure most times. She is still ambulatory with a walker, but she is pretty sedentary at this point.


I just don’t know what to expect if the battery is really running low. It is a whole new realm for me emotionally and medically and I would like to know if anyone has had any experience with this. Hospice is prepared to help of course.

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The only way to check the pacemaker battery is for the cardiologist to perform a "battery check" in his/her office.  Just because the pacemaker battery is 10 years old does not mean that it is running low.

Have you talked to your Mom's cardiologist about your concerns and asked him/her what the signs are of a pacemaker battery failing and how it will/might affect your Mom?
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My mother doesn’t have doctors anymore as she is on hospice. (I did mention it in my above question). She takes minimal meds. Lasix and Metazolone for her edema, metoprolol and magnesium. She has a nurse twice a week, and a CNA to help her 2 times a week. Also a social worker and a spiritual advisor. I found her card from when she had the PM surgery and it was almost 10 yrs ago. Jan 2020 will be the 10 yr mark). She also has persistent afib, valve problems that are probably getting worse, end stage macular degeneration (very bad and limited vision) and her mobility is not as good anymore.

She signed a dnr when she first went on hospice. At that time, she couldn’t walk 2 feet without running out of breath. While she is a little better now due to comfort care, she says she has had a good life and she misses everyone who passed before her. She is not depressed. I just don’t know what to expect when the battery starts to really run down. Maybe it is and I just don’t recognize this. I wanted to find out if anyone had experience with this situation. I plan on continuing to let her make her own decision about it. If she wants to do it, I will accept her wishes and bring her to the doctor for assessment. If she gets the PM, she will be dropped from hospice as hospice sees this as treatment. But they can pick her up again if she declines further - even after the PM replacement.
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AlvaDeer Oct 2019
To be frank, it is unlikely the pacer will run out before your Mom does. Very unlikely. And if it does it will perhaps just make it a little bit less time. I would not mess with this at all. She is on hospice and it sounds this is the best thing now for her. The pacer battery can be checked at her bedside if you wish that, but you will not see any dramatic changes if the pacer DOES stop and it is unlikely to make a huge difference for her. This is not like an off on button. Most people living WITH a pacer can live without it, as well, unless there are special circumstances.
Were I you, I would forget about the pacemaker. It is likely to go on more than a year more and if it does not it is unlikely to make any difference in her life. I would like you to speak to the doctor who put this in for her to reassure yourself if you are her POA. Please make an appointment if this is the case.
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Pacemaker battery and BP have nothing to do with one another. The low BP likely due to CHF medications. Why doesn't she want the battery change? It is in and out surgery. It isn't anything like when they put it in and had to place the leads. It is a simple cut, take out the pacer, slip in the new one and off she goes. My partner just had his third change, in a 7 and out at 12 noon. Is she saying she actually WANTS to die now, and this is a way she feels to get there?
As to the life left in the battery are you her POA for health care. A quick trip to MD office will measure exactly how much life is left in the battery.
As to what happens if she doesn't have it. That depends. If she takes a lot of meds that slow her heart rate, atenolol, beta blockers, digoxin (which almost no one takes anymore) and etc. then her heart may slow so much that it cannot sustain her and she will slip away. More likely is that, unless she had a profoundly slow rate, she will go on. Syncope is difficult to assess as to what causes it and frankly it is usually low blood pressure from medications. My partner got his pacer to enable him to take meds he needed to slow his rapid atrial fib without slowing his heart to a stop because he had a slow beat anyway.
I would explain to her first how EASY this surgery is. I would ask her if she is WILLING to or WANTING to die. It would not be a terrible death as death goes.
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Do u realize what it means to have a battery put in. She will need to be opened up to put a battery into the pacemaker. Then closed up again. There will be some discomfort. Maybe Mom doesn't want to go thru this.

I agree though, that a talk with her dr maybe good. My daughter has had patients die and you can hear the pacemaker clicking.
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AlvaDeer Oct 2019
It is no more than a little cut to the skin unless the battery is under muscle. It is really quite an easy and simple surgery. My partner, 78, didn't even need a tylenol after. In at 7 and out at 12 noon. I think the OP may think it is complicated as placement, with the leads. The leads won't be changed. This is a VERY easy surgery and hope the doc explained that to her. That said, no one likes anesthesias at this age. My guy had some fentanyl, so he was no out, but not in any pain, either, trust me.
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My aunt has Parkinson’s and is on hospice. Her doctor advised she replace her battery as it would cause a more difficult death....not an earlier death if she didn’t. Please speak to her cardiologist before making this decision. A new battery does not keep her alive longer.
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What does your Mom's cardiologist suggest?  Is he/she okay with your Mom's desire not to have a new pacemaker battery put in?  The procedure is done as an outpatient surgery and the person usually can go home a few hours after the battery (and any wires) are changed.

What does the cardiologist say about how the new battery or new wires or new pacemaker will affect your Mom's "end stage congestive heart failure"?  Will a new battery make your Mom more comfortable the last days of her life?  Why does your Mom not want a new pacemaker battery, does she think that it will prolong her life (and prolong her "misery and/or suffering")?  Does she think that if she does not get a new pacemaker battery that she will die sooner?

You need to talk to your Mom's cardiologist and get more information about how her pacemaker is affecting her life currently and how a new pacemaker battery will affect her life in the future.  If your Mom's heart is not responding to the pacemaker's electrical impulses like it should, then it might not help to have a new pacemaker battery inserted.

This is a difficult situation and I hope that you can assist your Mom to choose an option that will allow her to be comfortable during her remaining days.  {{{Hugs}}} and Prayers
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nymima Oct 2019
What you said makes sense. I don’t want any suffering. My mother doesn’t want to prolong her life and then have to deal with blindness, being immobile, not being able to breath at times etc.

She doesn’t have a doctor now since May of this year. Just hospice doctor and nurses. She sees the nurses twice a week. The doctor assesses her from the nurses notes.

I will call hospice soon and have a talk with them, now that we all know she doesn’t want to get a new pacer. TY
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