Pacemaker implant for a 98-year-old woman, does this make sense?

Hi MeDolly - I would say it depends on several factors. What is her current prognosis and quality of life? I know some of that is subjective.

My mother has a hip replacement at 99 and lived another 7 years without the hip pain she was having, It as a good decision for her. She was in very early stage vascular dementia at the time but still mobile for several years.

I'm not sure what you mean by "mental heath as to be expected for her age." I'm 85 and my memory is better than my kids. Mother taught herself to use a computer at age 95. More and more people are living past 100 and in better shape.

As I understand it, the medical procedure and recovery for this surgery is not that hard on seniors. I think Lea makes a good point about after care.

If she is still considered competent, I guess she makes the decision. She has that right. If she is not considered competent and family has to make the decision, one way is to follow what a poster here some years ago advised. Ask the surgeon if it was his/her mother what would (s)he decide.

I like justsotired's solution in the post below.

I just when through the pacemaker decision with my 99 year mother. She is in Assisted Living and the medical people there noticed her heart rate was very low. They contacted her cardiologist who ordered a holter monitor. I took her to have it put on and after only having it on for 1 hour I kept getting calls that her heart rate was low and she should get to the ER and have a pacemaker put in. I spoke to my mother and I knew what her answer would be, ABSOLUTELY NOT!! She has a DNR, POLST, Living Will - you name it. - and we have talked about if for years that she does not want anything to prolong her life. I realize a pacemaker is not for prolonging life, but she just wants nature to take its course. She has various other health issues and she is just tired of it all. She asked her cardiologist is she was being foolish and he said no. He adjusted her blood pressure meds a bit. I visited her today and her pulse rate was up to 61, it was 41 a week ago.

I’m sorry you are going through this. But if she is in her right mind, you may just have to go along with what she wants.

My mom had a pacemaker in her early 90s. My mom had hers checked once a year when she went to see her cardiologist. More often if we happened to be nearby. She lived 3 hours from her doctor.

My MIL could be checked over the phone. Some manufacturers have reps who go to hospitals and probably NHs. It was never a big problem to get them checked. Probably depends on where she lives and type of PM and perhaps other health issues.
When MIL was in the hospital, the tech came there. So brother could ask some questions about the aftercare. I know he must by toast with a 98 yr old to care for.

If it made your mom feel better for two weeks, much less 6 months, I would seriously consider it. But inpatient, outpatient, hospital delirium, hospital infections, all those things to consider.

One of my aunts, in an exercise class, thought she couldn’t detect her pulse and was doing something wrong. Neither could the instructor. She went to the ER and found she needed a PM immediately. She had hers replaced a couple of times before she died of Parkinson’s. She had no idea she needed one but after getting it she said she felt so much better. My cousin was told to let it stop on its own would be uncomfortable so she did have it replaced even after she had developed Lewy Body dementia along with the Parkinson’s. It is a pretty simple procedure with the ones I have had experience with.

Meds have side affects and don’t always provide the desired benefits. I discovered after months (maybe years) of having to adjust my DH aunts BP meds on a daily basis, based on her pulse reading, that Aricept was what was causing it to go low. It didn’t in the beginning but over time as her pulse decreased on its on, the Aricept brought it down into the low 40s.

Metoprolol also dropped her pulse. Until we discovered it was the Aricept, we would have to hold the metoprolol on the days it was too low and give an extra amlodipine to keep her BP down to an acceptable level.

Since taking her off Aricept and Namenda her pulse is in the 60-70 range and she feels better overall. We were trying to keep it above 50. So do check on her current meds to see if low pulse is a side effect.

Having said all that, DH aunt who is 96 and with dementia, told me years ago that she didn’t want a pacemaker. I was concerned a doctor would be recommending it until I finally figured out it was the meds that was causing the problem.

As CWillie said, hard to know what your mom should do w/o knowing her and all the details.

I wouldn't. But then, my friend's mom was 97 when doctors told her she needed a hip replacement. I didn't think it was a good idea, and neither did friend. Her mom wanted it, and she already had some dementia. We were worried about the outcome.

Mom had the replacement, went home and lived 4 more years. Not that she knew much of anything, but she could still get to the bathroom with help of her live-in daughter. She never had anything else that would have caused her to go to professional care.

Sooooo.....who knows?

It's hard to say yes or no without knowing your mother, although 98 sounds ancient there are increasing numbers of relatively fit seniors who are living well beyond the century mark. One thing you might want to consider that nobody ever seems to talk about - the very low heart rate and likely equally low blood pressure may contribute to cognitive decline due to the decreased blood flow to the brain.

My sister is a Kaiser surgeon whose had multiple interactions with cardios who are upset that they put these in people or agreed that they be put in their loved ones.

Having a pacemaker implanted is a relatively straightforward process. It is usually carried out under local anasthetic, which means your mother will be awake during the procedure. Most commonly, the generator is placed under the skin into the muscle near the collarbone. Dh had one implanted at 63 w no issues at all (unless a surgery is involved and a reset or monitoring is involved), and is 100% reliant on it these days. A pm has its own set of instructions, instruments to hook up bedside, appointments with technicians, etc, that people do not realize going in. Your brother will have more on his hands as a result should she choose to move forward with this.

Is a pm right for a 98 year old? Ugh, likely not, but if she's of a different mindset, then good luck. I'm sorry you 2 are dealing with this.

It's maddening to say the least that doctors prey on the elderly(just to make more money)with their suggestions to do procedures on someone almost 100, knowing that the side effects will by far way outweigh any good it may do.
And for what? So she can live another 6 months to a year? So sad.
But like you said ultimately it is your mothers decision. Here's to hoping she makes the right one.

Hi Dolly. My first thought goes to the elderly and surgery. My MIL had her very first surgery at 77. And she has not really bounced back from it, unfortunately. I have learned on this site that surgery and anesthesia can be hard on an older person. I agree with you and your brother's feelings about this. Praying for your peace as you have to navigate this with your mom.