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Do not do it. This is the reason I have joined this board. My father had the beginnings of dementia. My mom insisted he get a pacemaker and 2 weeks after the surgery he does not know us, where he is, and has been so agitated that I am looking for someone to care for them. He did it for my mom and now their life is over unless a miracle happens.
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gdaughter Jul 2019
Look up SAITO. Although he has dementia if there is a program near you they might be able to regain some of the cognitive ability he had prior.
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You have to look at the long term path ahead. He has expressed his desire not to have extraordinary care and the pacemaker will prolong life but as dementia progresses he will not even have the ability to rehabilitate (understanding how to exercise, etc.) Without support from others the road for you and him will be long and tedious. If mother and others are not willing/able to help, i'd suggest honoring HIS wishes. I have cared for my mother with progressing dementia for 7 years, now not able to walk independently, stay alone, do any care for herself and my back is breaking. take care of yourself too.
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I am the original poster: Thanks guys for the responses. Her personal finances are not materially affected either way, if he lives or dies. She has more money than she will ever spend. Both have excellent, comprehensive long-term care policies. His policy pays 100% of his care.

I don't know the first thing about pacemakers, so I feel that I need to be armed with real data to understand the short-term and long-term implications in having one placed in an 81-year old frail man with dementia. I fear for his future, and frankly mine too sometimes. Covering all bases with a dementia dad and a mentally ill mother is draining :(
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DILKimba Jul 2019
Upstream, my 86 yr old FIL with dementia just had one put in in January. It was an outpatient procedure and was very straightforward. We wrote notes and posted them all over his room and even on his mirror reminding him NOT to take the bandage off for 7 days. the staff at the AL were a great help. It has helped him a lot. It will not prolong his life, but has improved the quality by improving his sleep, and his oxygenation. Our biggest issue is getting him to leave the monitor that transmits data to hi doctor alone. We finally put it under his bed! Haha! Out of sight, out of mind!
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His life, HIS WAY!! So sorry!
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Is your dad's preference for quality of life written down anywhere? Does his POA form address the issue? You are absolutely right in wanting to carry out his wishes, and he's lucky to have you looking out for his interests. Have you discussed with your mom that your dad expressed to you a desire to avoid being bedridden? Does she believe you? Perhaps if you have a meeting with the medical team and your mother, you can explain to them the preferences that your dad expressed to you. At that point, the doctors should be on board with the idea that they shouldn't go forward with something he wouldn't want, and that could help convince your mom.
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Upstream

My experience appears to have been different from some of the other posts. I can think of three loved ones I’ve been up close and involved in when they got their own PM.

No problems at all.
One with Parkinson’s and dementia had hers replaced after going on hospice and all concerned are glad she did.

However, In your dad’s case, I would follow his wishes.

I would also try to get his POA from your mom. You might have missed your best (easiest) opportunity for that when you took his care over.

Regardless, I think I would impress upon her that if you have to file for guardianship of him that the funds to do that will come from his bank account.
She’s got quiet a record now you could mention that shows she isn’t really the best decision maker so a simple letter stating she will no longer be his POA would be the appropriate step for her to take. You shouldn’t have to deal with her over his care.
Your attorney could provide that document. Of course I wouldn’t go that far unless forced to.

I would think he was a drain on her finances unless he has a good LTC policy that’s paying for everything.

She has been so cruel to him (or is demented herself...can’t have it both ways), that I would want to protect my dad to live his life out as he saw fit.

This one is not hard to decide to me because you know what he wants.
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Upstream, are her finances affected if your dad passes away?

I think that your dad made his choice plain and clear when he was of sound mind.

Your mom, who knows what her motivation could be in having him go through a procedure that inserts wires into his heart, this is not an outpatient procedure. I can only think it is money.

At 81, with dementia, doing anything that will prolong the very existence he didn't want would be cruel in my opinion.

Try to discourage her from having this done.

Hugs! What an awful situation.
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Oy. My mom, with post-stroke Vascular dementia had a pacemaker done; her heart rate was dropping and death was apparently imminent. I was one of 3 health care POAs with my brothers; one brother was financial POA.

POA bro decided to ask mom, who was still technically competent, if she wanted Pacemaker, explained procedure and that doing nothing would result in death. She paused; clearly thought about it and said "yes, I want to do it".

So we did it. Awful night in ICU with temp PM; they didn't give her her antianxiety meds; after surgery, she woke up and said "Kentucky Derby!!". (The Belmont was the race that was being run that afternoon; she was "in the ball park" shall we say.

She lived another 2 years. Was it the quality of life I would have wanted for her? No. But we asked her and she said yes.

Ask your dad, if he hasn't been declared incompetent. It's HIS decision.
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NYDaughterInLaw Jul 2019
I echo this! If there is a time of day that he's still lucid, video record him making his wishes for his medical care, pacemaker, and end of life care clear in front of witnesses. Some attorneys have paralegals to make house calls for exactly such situations. Get your father the help he needs ASAP.

If all else fails, and you have evidence of your mother's abuse of him, get emergency guardianship for your father. Your mother should not be in charge of him; she does not deserve that privilege.
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The reason for the possible pacemaker is slow heartbeat. Dad would be very confused by the whole thing. He was very healthy up until the dementia kicked in and really only ever had two or three surgeries in his life.
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I would ask the dr what goes into inserting a pacemaker. I think its an incision where a pocket in made under the muscle and there are leads. A battery is involved, how often is that changed? Not sure if its a pacemaker my friend has or a Defibulator but the checkup is to shock the thing which my friend sometimes passes out.

The incision is painful. I am not sure if I would put an elderly person thru this.
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AlvaDeer Jul 2019
The incision is made in the chest wall and the pacemaker sits either under skin or muscle. The leads lead into the chamber of the heart where they regulate the electrical stimulus for heartbeat. Much more complicated with an implanted debibrillator which acts to shock the heart into regular rhythm when it goes into the deadly arrhythmias of ventricular fib. Regular pacers if for the chamber involving atrial fib. The new pacers have batteries that typically last for 15 years, was up from the 5 years when I was in practice as a nurse, and they are much more sophisticated. You generally go home the same day unless the doctor wants the functioning checked for more time on the heart monitors and keeps you overnight. The incision is not terribly painful, but in case of initial placement of pacer and leads you are somewhat limited in arm movement so that the leads scar in place to hold them. I do not see the sense to prolong life in someone elderly if life has become for them somewhat a burden. If someone elderly wishes the surgery, however, it remains they own choice, and the choice of the POA if that person unable to make decision, which should be decided on the stated wishes of that person when well, as they are acting not on their OWN opinion, but on the wishes of the person they are acting for. Ideally, that is.
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If your mother is technically or otherwise the POA you do not have a vote here. She is the one the doctor will go to and she will make the choice as your father is no longer able to.
I am a nurse. I would vote for honoring your father's wish. I would not place the pacemaker. I would be doing palliative care only now.
That's where I stand, but when someone ELSE has the power of attorney it doesn't matter where you stand. I would gently advise Mom that Dad would not have wanted this, and that his wishes should be honored. But really, that is the only power you have.
Pacemakers are not benign procedures and there is then the side problems of getting them checked, adjusted, medications, etc. That said, the procedure usually goes well and they are more and more sophisticated with less and less problem of battery changes, etc. The problem with the elderly is that during that window of time waiting for the leads to kind of implant (think of a fishhook to the chamber) with scar tissue, a radical movement can displace the leads. In the elderly impaired this can happen more readily than with the young. I do not know the reason for pacer. I have Chronic Atrial Fib which my spouse has also. I chose no pacer and he chose yes. He is in fact on his third battery change in a few months and I am still beside him. His was placed for a slow heart beat, and more problematic thing. There are many different reasons to place them, just to tell you I am about 20 years out with chronic fib and an aspirin a day. So far still here. It's a spin of a wheel chance whether you do it or don't do it, as to which would give best quality of remaining life.
IMHO
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JoAnn29 Jul 2019
My friends leads became intangled causing her a lot of pain.
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