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My Father had a heart attack 2 years ago. At that time they replaced his pacemaker with a pacemaker defibrillator. Since then his dementia has increased and he is not eating. Shortly after he came home from the hospital 2 years ago he got a feeding tube because he was deteriorating rapidly. We did this with the hopes that his appetite would return and life would get back to normal. But that didn't happen. He still has the feeding tube and has gotten very weak. He sleeps all day but has no quality of life and he's sad. A few weeks ago he went on hospice. Since then we had his defibulator shut off but his pacemaker was still going to be operating. Last week his pacemaker began to beep indicating a low battery. Given his condition I don't think a doctor will be willing to put him under to change the battery. I'm very torn. I don't want my father to suffer but I don't want my lack of action to accelerate his demise. When he's awake he's alert and aware of the fact that he's been in bed all day, every day...and he's sad. Should I try to pursue getting the pacemaker battery changed? I'm very conflicted. Any insights would be appreciated. Thank you.

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FGRINSTIX: As I am not a medical professional, your question should be posed to your father's cardiologist.
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replacing a battery is outpatient. The wires are not replaced. Only the device. It's like opening the skin flap that holds the battery, take it out and put a new one in and attached the wires, and they use some kind of "superglue" which holds well to suture the skin. Done. Sometimes lethargy is due to excessively slow heart beats. If he is near death, that's another matter but if he has some life left sure why not replace it. Now if he's still walking DEFINITELY get the battery replaced. If the battery has been low a long time chances are it was not sensing and capturing heartbeats which may account for lethargy. Just a guess. A lot of other things can cause lethargy. A LOT.

If hospice is against it, simply revoke the hospice (sign a piece of paper) and his regular Medicare will pay for it. When discharged put him BACK on hospice by signing a piece of paper. It's really very simple. You won't even need a doctor's order to reinstate it. As long as a hospice doctor never discharged him due to improvement he will always be on hospice whether you revoked it or not. So even if you are not happy with your hospice, you can fire them by signing that paper and put him on a new hospice by signing a paper and no doctor order is needed.
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The doctor advised us that my mother would be very uncomfortable without having the battery replaced. The pacemaker was not keeping her alive so the question of a new battery was more of a comfort issue than prolonging life. She was under local anesthesia and did just fine. I really haven’t thought about that decision since then……. I pray that you can decide and move forward knowing that you have done your best in providing love and care.
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It’s so hard to make decisions as our LO inch towards the inevitable. It’s another grief filled stop along the way. Several things to consider: hospice may consider replacing the battery a life extending action and not recommend it, or ask that your dad be removed if he does get the battery. There was a reason you placed him in hospice. Dementia is progressive. No matter what you do, it will get worse and there will be no more moments of lucidity. Would he survive getting the battery? Would he be incredibly confused and agitated in the process?

I had to consider quality of life versus quantity of life with my brother when I chose to put him in hospice. Would you and your dad want to continue this very sad life? In some ways you answered your question. I don’t believe you are hastening his life. The pacemaker extended his life when it was very appropriate. All the lifesaving technologies have their place but the end of life isn’t that time. By the time I placed my brother in hospice my goal was quality of life and comfort. You may want to ask yourself if you were in his place, would you want a new battery? Getting closer to the final good bye is never easy.
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(1) Ask your father. (2) Talk to hospice and get their views. (3) Talk to the doctor and get his advice. (4) Make your decision based on gathered info.
P.S. - two years seems like a short life span for a pacemaker battery. Are you sure this is what the beeps are about?
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I know this must be a horrible, weighty decision. Whatever you decide, please allow yourself to feel no guilt. With the extent of your father’s dementia, if it were me, I don’t believe I would make the decision to have the battery changed. I’m assuming they would use anesthesia, and I’m sure you know that likely will set his dementia back even further. It is horrible to be in charge of someone else’s life or death decisions.
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We all have to wrestle with decisions like these when LO in advanced dementia…. I did when my husband developed aspiration pneumonia because he stopped swallowing… and I had to decide about a feeding tube…. I absolutely knew my husband wouldn’t want it… but it was difficult decision just the same. You can always find doctor to operate and clergy to insist
prolonging life … but the way I tht about it was … even if these measures were to be successful… what quality of life are they coming back to … . And would they want it ??? The next day g-d had taken the decision out our hands and my husband passed. Anyhow always lots great advice here … this site always been my go-to .. hope helps you too … good luck !!!
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Since you have placed him on hospice, I would suggest letting nature take its course. When the battery goes, let him go.
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Taylor; We aren't talking about a hearing aid. Replacing a pacemaker battery is an invasive surgery that requires sedation/anethesia and a stay in the hospital. Very disorienting for a dementia patient.

When my mom was well into dementia, she developed heart block which required a pacemaker. My brother's and I all held joint POA for health. My mother would not have wanted this in her younger days, but we asked her if she wanted the surgery and that the alternative was dying rather quickly and painlessly. She thought about it for a few moments and said "yes" she wanted the PM.

FGRINSTIX, can you ask him in one of his lucid moments?
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Yes he has dementia - he isn't without feelings and wanting to be shut off from the world to save the cost of a few batteries - the mind boggles that this even arises as a question. Oh he's got dementia lets shut him off from hearing anything he'll be ok in his own little silent world - ye gods how selfish and ignorant can some people get.
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Isthisrealyreal Aug 2021
The batteries being asked about have nothing to do with hearing. Look up pacemaker and then come back and apologize.
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I am so sorry for your heartache and hard decision.

I am caring for my mom since her stroke and several times have had to “think really hard” about what mom would want (and I say this from the ICU after her stroke to toxic encephalopathy - feeding tubes though she now eats on her own to even some of the bad UTIs before I knew about how awful they are - each time I think about moms wishes - sometimes I even take out her health care proxy etc and re-read her wishes several times before I choose anything for her. I feel comfortable that when the time comes that I will honor my moms wishes - as well as make any decisions that would always protect her to comfortably pass when it’s her time - I think because we are close and always had these talks that I know my mom is not afraid to go when it is her time - she talked about it as her beautiful next journey so I know these talks will always help guide me and I’m grateful for those talks we always had.

It so hard making choices for someone else and to feel we are choosing what they would choose. I think you are here asking From pure love and I believe you don’t even need us to help answer this - I think you know and you came here for support and You will receive all the support in the world - you deserve to feel comfort in knowing your Dad will be okay and you don’t need to put him Through anything else - he knows you would if it would give him something better. I’m giving you the biggest hug and wishing you peace and comfort.
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FGRINSTIX Aug 2021
Thank you so much ❤
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Your father is on hospice care b/c he's reached the end of his life and wants to be kept comfortable until he's called Home by God. For that reason, I would not have the battery replaced in his PM at this time.

My mother has advanced dementia & I pray every day that God takes her Home. Her quality of life is dramatically reduced and she's in pain every single day. I would never take ANY life extending measures for her under any circumstances, so I say these words to you as if it were my mother I was making this decision for.

There comes a time when extending an elder's life is nothing but cruel. Allowing them to transition into the next stage of their life is the best thing we can possibly do for them, in my humble opinion.

I'm sorry for your situation, and I wish you peace with your decision.
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Thank you for your comments and insights. I truly appreciate your taking the time to help.
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My father would absolutely KILL me if I attempted to prolong his life in such a state. He’s the “plug the plug” kind of guy, and very big on ‘quality of life’ and having dignity later in life.

If it was my child, I’d do whatever I could as they have so much life left to live. But with my parents, I wouldn’t prolong the inevitable, just for my own sake. They wouldn’t want me to. And I don’t think I’ll like to suffer that way either.
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FGRINSTIX Aug 2021
Thank you for your comments and insight. I truly appreciate your taking the time to help.
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My prayers, thoughts and hugs are so with you. The two previous respondents have wise answers. As hard as it is, contact his cardiologist, and his primary care provider, the Hospice care group, and a spiritual advisor ( if that is comfortable for you) ask for guidance and advice. When dad is awake and alert, spend positive times. Take care of yourself right now, too. God bless you and your dad.
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My dad’s pacemaker needed a battery right about the same time he went into his final decline. We didn’t know how soon he’d be gone but we discussed the procedure with both hospice and his cardiologist. Both agreed not to do a replacement, that it would be hard for him and the pacemaker just wasn’t as important anymore. My dad was very aware and was fine with doing nothing. In the end, his heart failed on its own with the pacer making no difference
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FGRINSTIX Aug 2021
Thank you for your comments and insight. I truly appreciate your taking the time to help.
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He must be pacing all the time for his battery to be low. 2 years is nothing for the life of these things.

I would contact the cardiologist that installed it and find out what is causing the battery to be going.

Honestly, I wouldn't put him through it. It's a pretty easy surgery for the battery but, you will have to remove him from hospice to have it done and he might not make it through and he will be put under anesthesia, so the risk of further decline is great.

My dad was not doing well and he had a triple bypass, all because the surgeon wanted to operate. He did not make it out of the hospital. He was pacing 70% of the time and lasik wasn't pulling the water off anymore. My point is that you will find a surgeon willing to operate, even if they know that certain death is the end result, do not use that as your determining factor.

Look at the quality of his life and decide from that.

I am so sorry that you are losing your dad. May God give you strength and wisdom to make this decision.
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