My husband has Alzheimer's (4 years since diagnosis) with severe cognitive decline. He had tests after a mild stroke this summer and might need a heart pacemaker. His doctor says his heart arrythmia is not life threatening but he might get dizzy and fall and hurt himself. She (doctor) said that if my husband was in a care home she would not recommend a pacemaker, but since I am trying to keep him at home with best possible quality of life he should get the pacemaker (pending results of further tests) to prevent a serious fall. Before his Alzheimer's became severe, my husband and I discussed whether we wanted life-extending interventions and he did not. My son says it is my decision. My youngest (a daughter) wants everything medically possible to keep him alive as long as possible. Has anyone else faced this issue? I have seen in the internet that pacemaker in this situation is a controversy.
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Choosing a pace-maker, or not, is more or less about extending his life. With a pacemaker, he will have less dizziness and possibly more energy. A pacemaker will not guarantee that he will not have a serious fall - there are a lot more factors that attribute to falls than heart rate and blood pressure. He will need to be able to stay in the hospital for the procedure and while they monitor his recovery and possibly for a few days until his pacemaker is calibrated correctly for his needs. He will need to be able to leave his surgical site and dressings intact, not disturb his IVs or urinary catheter, and deal with the unfamiliar surroundings and protocols of the hospital. Only you know if he can realistically deal with these issues or will need to have a paid sitter with him 24/7. Consider how he manages with changes in his routine at home as a guide to how well he will deal with this major change in a hospital.
much appreciate your replies
I am not certain what changes they hope a pacemaker will be. Has your husband worn a holter monitor to see how his heart rate acts during the day? Does he get up slowly to adjust for blood pressure changes when raising out of bed or chair?
In general pacemaker surgery is without complications usually, and the person is not fully anesthesized to get a pacemaker. Batteries now last upwards of 10 years. But I seriously question whether these falls are due to any heart rate problems? I am not seeing the connection unless they explain it to you more fully. I would be certain they explained the connection they think is there completely and to your understanding.