Invasive procedures to prevent death from heart attack, or treat with meds and wait for the inevitable?

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My 88 year old Mom who lives with me and my husband has had coronary artery disease for years. In the past she's had a triple bypass and three stents, as well as a pacemaker. Then the dementia came. Slowly at first, but she is well into now, with a memory span of about 5 minutes. She has a very sweet disposition. Medicine has kept all of the heart problems at bay for a long time. All of a sudden it's back....the chest pains....unstable angina. Tests have revealed she has another blockage, and the cardiologist wants to do an angiogram and most likely an angioplasty. I am doubtful she would survive these procedures, as she is quite frail. And another worry is that it may likely set her dementia further along. She has just spent a night (last night) at the hospital as a result of pain that couldn't be alleviated with the Nitro, that has been working up until last night. The hospitalist we conferred with last night said that this would be happening more and more now, and if we are not going to take the next intervention step with the heart procedures, we should enlist the services of Hospice vs: trips to the hospital. He seemed to question what good would it do to subject my Mom to these invasive procedures which may make things better (or NOT) to live a quality of life that is diminishing and only to get worse and worse. I'm in a quandary about this. Do I have her heart problem fixed? Could she be worse off in the dementia scenario as a result? Or she could die even from the procedures which have their risks. Or do I call in Hospice and keep things as comfortable and decent as possible until her heart gives up? What would you do? (I spoke w/ Mom early this morning at the hospital, and she's as confused as ever just from this one brief thing. That's why I worry about all of the stuff involved with surgical procedures, anesthesia, etc.)

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You were a good daughter and did all the right things. When it is my time, yes, give me a cup or 2 of Earl Grey in my favorite teapot, and set me free.
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I too am sorry for your loss but am glad that your mother was in good spirits up until the end. And I'm glad that you no longer have to face the alternative of two difficult decisions.

I'm sure your presence with her provided a great deal of comfort in her last hours.
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Braida, I am sorry for your loss. Your mom was very fortunate to have you care for her, up until the end. And from the sounds of it, you did a wonderful job! She is very proud of you.
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I'm so sorry for your loss, but it sounds like your mom was very blessed in how she left this earth - with you by her side and doing it exactly as she wanted. {{{Hugs to you.}}}
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Thank you for your answers. So much has happened since I asked the question. My precious Mother died last Thursday, May 22nd. It was heart related. I hate that she is gone and miss her terribly. I didn't expect things to happen so soon. But I know she wouldn't have wanted to linger and go further into the dementia scenario, because she never never wanted to go elsewhere and live.(like a nursing home) She always wanted to stay at my home, and have her kitty, and have all the nice special things that I could do for her....a one on one experience. She would never have survived a nursing home experience. So, as sad as I am to be left missing her beyond description, at least she was still walking, talking, eating, laughing, and being herself right up until the last few days, when her heart began giving out on her, and she felt unwell. Even on her last day, she picked up her cup of tea and sipped it, and had toast. And it was the way tea should be made....not hospital tea, and toast on the bread she loved. Little silly things like that make a difference to certain people, and my Mom was one of them. I wish I could grab her back. But I'll just have to cherish the sweet and precious memories. Thanks for being there with your helpful input. Hugs to you all.
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Anesthesia can have a profound effect on all elders but especially those with dementia. The effect of anesthesia on the brain may or may not reverse. In my moms case, she had surgery with general anesthesia. While she had cognive problems before the surgery, they became much more pronounced following. That was when family finally realized what was occurring in her brain. Or, when family started to pay attention!

My mom has a living will and DNR which she completed when she was competent. She would not want to continue to live if she understood the effect Alzheimer's has taken on her brain. A few years ago she wanted me to help her die. This was when she understood, somewhat, what was happening to her.

My thoughts are to bring in hospice and let nature take its course.
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This is a very difficult situation, one that many of us have had to make to varying degrees, including myself.

Taking her age and the dementia into consideration it's my opinion that your mom will come out of the procedures worse than when she went in. The anesthesia alone with exacerbate the dementia and most likely your mom will never fully bounce back.

Surgery at your mom's age with her dementia is very aggressive treatment and you and your family need to decide what your mom would want and what's best for her in the long run. I think hospice should be seriously considered and I think it was appropriate for the Dr. to suggest it.
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Second thoughts: last year my 95 year old father broke his hip, second fracture. The cardiologist was very, very reluctant to grant cardiac concurrence for surgery. Certainly he was understandably uncomfortable with the liability, but he also weighed the situation from my father's perspective.

If my father wasn't able to get the fractured hip repaired, he would be bedridden for the rest of his life. And we all agreed that would not be the kind of life he wanted.

I knew that there were risks to the surgery, but if my father didn't survive it, at least he would be spared the indignity and misery of living a bedridden life; Dad and I both knew he would decline rapidly and spent his remaining life depressed and miserable.

Almost one year later, he's successfully recovered from the fracture and is walking without a walker. (He also had a pacemaker replacement a few years ago and faced similar cardiac issues then and still does.)
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So your cardiologist wants to undertake surgery but the hospitalist disagrees? How long has the cardiologist been treating your mother, and do you have confidence in him? Would you also be able to accept the fact that the surgery may be too difficult for her to survive? Has your cardiologist addressed this and given likelihoods of survival?

I feel for your pain and dilemma - you're really between a rock and a hard place. These are decisionos which no one should have to make, but unfortunately, we do face them.

This is the way I would see it: the surgery may be successful but may advance the dementia. Would you be comfortable with that outcome, i.e., more stable cardiac health but more challenging mental issues?

And, most importantly, what do you think your mother would want? Are you her sole caregiver? Are there siblings involved with whom you would want to consult?

I've dealt with dementia but probably not as much as most people here, so it's hard to put in perspective what your mother's quality of life is now, although it doesn't seem good.

I would actually risk the surgery, assuming I was prepared to care for her either at home or at a facility. I had to sign the DNR order for my sister and it was an act of mercy but I still feel uncomfortable about having done so.

Honestly, and I don't hope I sound callous, I would opt for the surgery, if your cardiologist (not the hospitalist) gives a reasonable chance of success. But I would also balance that with whether or not you could continue to care for her at home or whether you would need to consider a placement, which would probably be more challenging mentally for her.

Wish I could offer some better advice but this is such a difficult, and personal situation, and I think really turns on what your mother would want.

I hope you're able to find peace with whatever solution you choose, and know that you've done the best for your mother.
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So sorry hugs to you.

IMO this is the reason why my Mom has a "Living will". We discussed this when she made me POA and she did not have dementia.

If you want to know what I would do then I would not have surgery.. I know it's a tough decision but she needs you to be brave for her..She entrusted you with her wishes..

Whatever you decide I will be thinking of you and Mom.
Best wishes my AC friend...
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