Should I consent to a pacemaker for my aunt or proceed with hospice/palliative care?

My mother had CHF and AFib. On the recommendation of her cardiologist, about a year before she passed away, she had a pacemaker implanted. His concern was her having a stroke, and my mother's concern was not that a stroke would kill her, but what would happen if she had a stroke and it DIDN'T kill her.

The pacemaker did not cure her CHF, nor did it extend her life. When she went onto hospice, we had the defibrillator part of the pacemaker deactivated - a very easy, non-invasive, procedure done in her cardiologist's office.

When she had the procedure, they used very (and I do mean very) light anesthesia - she said she was awake for the entire thing but numbed so she felt nothing.

You should have a conversation with whichever doctor is recommending this - both the pros and the cons of the procedure, as well as what death will "look like" when she gets to that point.

I was in favor of her having the procedure done, simply because of her increased risk of stroke, and the possible complications that would arise from it should it have happened and she survived it.

Alva gave you good reasons why a pacemaker would jot help your Aunt. My daughter is an RN working in LTC. Pacemakers don't prolong life. When the heart stops it stops. She says you can hear the pacemaker trying to do it job but it can't.

You really don't want her getting anesthesia either. It could make her cognitive decline worse. Me, I would rather have my mind longer. The discomfort afterwards and the poking and proding.

I would have her evaluated for hospice and have a psychologist talk to her if she really is tired and really wants to prepare for dying. A pacemaker might make her miserable if she already has many other health problems. If not hospice care than maybe pallatitive care. Doctors are trained to extend life at any cost and that isn't always in the best interest of the patient. I can't make the decision for you, but if she really wants to let go, that might be the best thing.

Alva below wrote “A pacer would in someone with low beat keep them from falling, passing out, have too low pressure, but I just don't think it would cure that pump.”

Is aunt mobile?

If she is mobile, I would give her the pacer.
If she is bed-bound, I would not.

Is she on meds that reduce the pulse? If so, I would modify or stop meds and see how her pulse responded. My DH aunt was on two. NO DOCTOR told me this. And she had good doctors. One a geriatric primary she still uses. I found out by chance.
After removing the chief culprit, her pulse returned to normal.

Now this didn’t happen overnight. It slowly decreased her pulse. I was working with juggling her BP meds to keep it above 40. In her case it was the Metoprolol I juggled (with drs help). But two or three years later when I stopped the Aricept and then Namenda, the pulse returned to normal. So now she takes the metoprolol each day, no problem and no pacer.

I truly believe the medical establishment pushes pacemakers for the super elderly like my mother because it is a huge money maker for the hospital and the cardiologist. It cost $215,000 for my mother's hospital stay and pacemaker. This was covered by the taxpayer (Medicare) and her supplemental insurance and it was not about my mother's health and well being. This pacemaker was implanted because they made money.

I really wish she had some better bonus time than what she is currently enduring. Maybe for some elderly this is a huge improvement and results in more enjoyment of life. In my mother's case it isn't.

I would opt NOT to have a pacemaker put in.
I would request Hospice.
It sounds like this is the decision she would make.
Have you talked to her about it or does she grasp the situation?
🙏

My dad had years of CHF, and a pacemaker was part of this time. It did stop the abnormal beats and keep a normal rhythm but did nothing for the fluid build up that is the curse of CHF. He took oral Lasix in ever increasing doses, and then began a series of hospitalizations to pull off more fluid than oral meds could do. These hospitalizations were exhausting for him, he always came home at a slightly lower level of function, weaker every time. When this stopped being effective, he chose home hospice, was kept quite comfortable, and died peacefully in about 7 weeks.
Be very sure the pacemaker has benefits that outweigh your concerns, know the fluid build up is inevitable, know to shop hospice agencies if that is what you choose as they are not all equal, and know that she can be kept comfortable as the meds of hospice are compassionate and effective. I wish you both peace

It can be hard to differentiate between grumbling and hopelessness and someone's true desires when their back is to the wall, have you had an honest conversation with her about this? Did the doctor not sit with both of you and outline both the pros and cons? To me this is a conversation about her quality of life not about longevity, if the pacemaker would make her physically more comfortable then I would consider it , but only if SHE wants it.

Seems she had made up her mind. Please honor her wishes. 🙏🏾

True stories lady in her late 90s ( 98), had a medical setback. The priest came to talk to her, she said she was ready to go, and so she did on Christmas night.

Another one bedbound male resident in a room no window to see storms, sun, snow, just a darkened corner of the room. He definitely was ready to go ( and did) because he ate what he wanted and really had given up. Both residents are at peace.

I personally as an ex cardiology RN, at 81, would not have a pacer put in. I have known atrial fibrillation for 10 years. I don't take blood thinners and have no pacemaker. I take a baby asa daily.

I do not personally see how they feel that a pacemaker would help her CHF overmuch. CHF is basically heart failure-- left, right or both. So I would ask for all of that to be drawn out for me in great detail. As in "Could you be very specific for me the ways in which you feel a pacemaker would help my Aunts Congestive heart failure".
Other than a heart transplant or valve surgery, there's no cure for a failing heart. Usually the treatment is diuretics to keep fluid off the lungs and the peripheral areas. Often measurements of labs are required because these diuretics wash out electrolytes along with fluids, so they are sometimes not given in Hospice situation.

I personally would choose palliative and hospice care. You MAY be prolonging life. You may not be. Pacers work on the "electro-mechanical systems" of the heart if you will; they trigger heart beats, are set to slow or regulate heart beats, are sometimes used to maintain heartbeats at a certain level when medications that lower rates are used in increasing dosages.

You might consider doing a bit of your own research. Look up "pacemaker for congestive heart failure" and so on.
You know your Aunt's wishes better than we do, hopefully. And from what you say I would be doing no procedures that could prolong life.

As sad and as hard as it is nephew, it sounds like your aunt just wants to go on her next adventure, what ever that my be.

I'm sure it's hard to make that kind of decision on your own.

Best of luck to you

If she is in a NH, no I wouldn’t.

My mother at age 94 had very little quality of life, mobility and toileting issues. She was a shut in and had not left the house except for doctors appointments. When She was unconscious in the hospital after a cardiac episode my father gave authorization for her to receive a pacemaker.

It really did nothing to improve her situation. She still is not mobile and cannot toilet herself and is very depressed. sShe can linger like this indefinitely because she has no other life threatening health problems.

She was home when she received the pacemaker. She is in a NH now and can be there for years because of this thing.

So based on my experience I wouldn’t do it. It is not humane.

waytomisery is correct. Get her evaluated for palliative/hospice care.
I’d be scared too getting a pacemaker..

Your aunt is “ hating her situation” and is “ just waiting to go “ . Forget the pacemaker , she’s tired of life and is ready to go. Let her go on palliative care back at her nursing home.