Pacemaker for Centenarian

[Pete1017]

My father in law just celebrated his 100th birthday.  He is frail, has congestive heart failure, and lives in a nursing home.  The cardiologist there said that he needed to replace his 8 year old pacemaker.  Obviously, the operation would require transportation to a hospital.  Does this make sense?  Is the risk of an adverse outcome outweight the risk of not having the operation performed?  Thanks for your thoughts on this.

[Yvette BG]

I agree with itdood about asking lots of questions. I think I'd also ask what the doctor what s/he thinks the prognosis would be if your father-in-law does NOT have the surgery? How long does he think it would be before symptoms get worse? Overall, based on his experience with other patients of like age and state of health, how likely is it that your FIL could be kept comfortable if he chose not to have the surgery?
Also, I'd ask if this was his FIL or his Dad, based on everything he knows, what would he advise him to do?

My heart goes out to you. My parents are both in their 80s and have had open heart surgeries and other surgeries over the past 3 years. These decisions on whether or not to have surgery are complex and can be so tough; if only we had the crystal ball and could see what the outcome would be after the surgery and what it would be with no surgery!

The anaesthetic (sp) thing can be a biggie, though. If your FIL has some confusion or cognitive impairment, I would definitely ask whether an anaesthetic could be used that would have the least possible impact on brain function. Some are much harder on memory and brain function than others.

I would ask the doctor how long of a hospitalization he would expect and also whether there would be rehab/physical therapy, etc. afterwards. If yes, could that be done at the nursing home where your FIL lives or would it have to be done elsewhere? For my Mother (who has mild dementia) who underwent extensive PT, etc. after brain surgery
as well as heart surgery, she finds therapy very intrusive, adjusting to the new people
on the therapy team (in addition to the new nurses and doctors at the hospital)
very upsetting, etc. and now refuses to consider any more surgery of any kind if it is going to involve any type of rehab. This includes surgery which may prolong her life (she's 82). This may not apply to your situation, but I mention in case it is a consideration.  

Good luck. Please let us know what you decide.

[Pete1017]

Make that "suggesting" those questions. Mea Culpa!

[Pete1017]

ITDOOD:  Thank you so much for suggestion those questions.  We find out that information before making a decision.

[itdood]

If it were my father, I'd want to know a few more bits of info before making the decision.

Things like

Do they need to replace the leads? (lead placement seems to be a bit more invasive than the pacer itself)
If it's just the pacer, is it a simple subcutaneous procedure?
What is the minimal sedation he can be given?  
What experience does the surgeon have with patients this age?
Does the manufacturer recommend this interval?  (8 years)
What's the actual failure rate of these pacers at 9,10,11,12 years...?


I think the two biggest risks are the sedation and lead placement if those have to be replaced (more than likely, yes).

I'm a bit leery of giving any advise without more info, but based on what I know and on the outside looking in, I'd say replace it based on options.   I think the risk to replacing it would be lower than letting it go.   But if your Father in law can still make decisions I'd have a conversation with him to see what he wants.