Not having medical procedures in old age

@MotherOfCatBoy

Just a bit of advice going forward. Pacemakers can be reprogrammed, which you probably already know, but the physiologists (AKA tech) can extend the life of a pacemaker battery by putting it into a more simple mode so if he says he doesn't want another, which is fine, encourage him to go for a check and ask them to extend the life.

It’s hard. My DF is 96, has a pacemaker, takes regular meds for a blood condition and has recently been fretting about high blood pressure. He’s mobile, if wobbly, and is vocal about batting for 100.
My DM 88 is also mobile and independent, but has creeping heart failure, is pre diabetic, and has a host of mental health issues. She drifts about in the garden and seems lost in her own world unless she’s being hostile. I have a feeling she will continue to worsen and wouldn’t be surprised if the same vascular dementia that got her sister takes her the same way. I pray she won’t last too long if that happens.

This is something I’ve thought about a lot. My husband’s side seem to live long and get dementia. A death repeated to dementia is pretty miserable. For one of his grandparents she got to 92 but the last 18m were such low quality of life. She was constantly falling and black and blue from bruises, got so so thin she was emaciated etc. She had pneumonia a few times and being a bit more distant often thought it would have been kinder to stop the antibiotics and let her go.

My own parents have said they don’t want life prolonging treatment in their POA forms if they had dementia. I also think they’d refuse cancer treatment at this point if that became an issue. It’s such a tough balance. My granny has a pace maker in her 80s and had a very active fulfilling life until she developed cancer. She had no treatment for that and her final months were hard to watch but I’d rather go her way with 85 great years and 2 horrible months than 2-3 years of poor quality life.

what you’re missing is that what you call “life extending” treatment can often kill, or shorten life expectancy in the elderly.

like my Ds’ fil who opted for “life extending” chemo only for the side effects to kill him in 6 months. He’d likely have had years without it anyway.

surgery, anaesthesia, medication all have risks. More so if you’re older. Recovery is harder. Stroke risks are vastly increased.

there’s a reason a leading cause of death for the elderly is breaking a hip. There’s a reason that if you’re elderly and go into hospital chance is you don’t come out. Keeping mobile and active is key and any hospitalisation will involve a period of inactivity, which is counterproductive.

so it’s not as simple as “opting for life extending treatment”, even if you’re fit and well and mentally competent. Not only may that treatment kill you or shorten your life expectancy, it may impact your quality of life negatively rather than improving it.

personally I wouldn’t have any sort of intervention unless my quality of life was so bad it couldn’t really leave me any worse off. Rather 6 good months than 2 bad years.

It's a very interesting question, one I often ponder whilst watching Surgeons At The Edge Of Life ( fab programme IMO).

Trouble is, you cannot predict when you will feel enough is enough. At 40-50, 75 feels forever away but I know my late 70s ILs enjoy life a lot and would definitely take life extending treatment. I know another elderly lady who was fab until 90 and all treatments would have been worthwhile. She then developed various issues declined quickly and declined cancer treatment, her quality of life was too poor although she had full capacity.

So, physically, it's too hard to call. I am sure I wouldn't want life extending treatment if my mental capacity was impaired but perhaps I just haven't had enough experience to know.

Sorry I did not mean to quote your post and it won’t let me edit it now.
I must have hit the wrong button.
Apologies

My parents refuse all treatment, no way would my dad survive a general anaesthetic. At a certain stage, interfering can make things worse.

Just my own observation, Dad has outlived another man with same conditions by 6 years, the other man had surgery and all treatment and his last few years were in and out of hospital and recovering. Dad is still ok.

Dad is a once off though 😁

Well the old joke goes “who would want to live to 100?”

“A 99 year old”.

I do feel sometimes medicine is practised in denial of death, it’s difficult.

Thanks for this thread, thought provoking.

My mum didn't ever exercise. As soon as she retired she took to her armchair. Her non-recovery from the hip replacement was no surprise to anyone.

But I know in active people it can be an absolute life changer. I think, for my mum, it was to ease pain more than restore mobility. But it was the anaesthetic that I think was the real life changer for her...

My Mum's GP suggested her chemotherapy might have brought on the dementia. She also had two lots of general anesthetic in the years before diagnosis...

My Dad’s neighbour has just had her second hip replacement in her mid 80s. She has slowed down and tires more easily but is back at the gym 3 times a week and is always out and about with friends.

It was definitely the right thing for your stepmum to qualify for a pacemaker despite her advanced age as she still has quality of life.

There would seem little point with your MIL by contrast so that just goes to show there can’t be a “one size fits all” approach but an honest assessment re quality of life considerations.

When FIL was on end of life care in a dementia home, some doctor prescribed antibiotics for a chest infection which meant he lingered longer. A chest infection used to be the thing that carried them off earlier. I could have rung that doctors neck!

I know that not having a pacemaker when you need one can condemn you to sitting looking at the walls until you die. Step mum is in her 90s and went from that to going out with friends to cafe/garden centres. Yes she has some cognitive decline, forgetfulness etc, but she's in her 90s, it is normal.

Why should she have to just sit there waiting to die, not being a nuisance.

Trouble is there is a fine line between living and feeling alive. I'd rather her last few years were comfortable and happy - even if she develops dementia. (Some cognitive decline with aging is normal)

MIL, on the other hand, has late stage vascular dementia and is in a nursing home bed 24/7, nothing can be done to improve her quality of life, she will gradually shut down function until she dies - or, quite likely, aspirates food and contracts pneumonia. She has a variety of non intervention directions. She would not, for instance, have a pacemaker fitted.

My mother had a hip replacement at 80. The anaesthetic gave her odd delusions which she reported with glee, but which I am almost convinced tipped her over into dementia (of which she had shown absolutely no sign previously). She recovered well but, having not exactly been active before the operation, she did no physical rehabilitation afterwards and simply resumed her wheelchair bound life despite the new hip. A friend's mother (who is in her 90's) is being told she needs a hip replacement, but I think they're delaying the operation in the hopes that she dies naturally before her name comes up on the list.

This is very true. It's the same with young people who really believe they would rather die than be paralyzed but if they are actually paralyzed realize that they do want to live.

My MIL had a hip operation when she was 90 something. She was in pain and apparently hip operations have a very high success rate

I have a very similar view to you. But I have questions.
If you refuse treatment after a heart attack or stroke, or refuse stents or pacemakers, do you just have a lot more symptoms and disability rather than dying? If you refuse antibiotics for flu, are you just going to end up needing hospital care? My MIL recently fell due to an infection in her finger which made her arm blow up hugely. If she had refused antibiotics she would have needed help with self care, had a lot more pain, but not the 'sooner death' we are all imagining when we talk about this issue?
I know Shipman ruined it, but I would prefer a careful management of death by doctors without too much paperwork or discussion but with the aim of dignity and reduced suffering.

In my experience 85 is the point where things start going downhill. I know several 80 years olds who could easily pass for 10 years younger, and are very active. I've certainly never noticed a striking decline between 75 and 85 in anyone I know.

I do think prolonging the life of someone with severe dementia is cruel, but not everyone develops dementia at an early and the majority of 75 year old people around here are still more than capable of enjoying life.

I hear you OP.
My mother-in-law is being kept alive by medication that has horrendous side effects requiring lots of other medications. She is on heavy pain relief. She is housebound. Her quality of life is practically nonexistent and her children are providing 24-7 care to support her to stay at home, severely impacting their quality of life, their family and work lives and causing a great deal of stress and anxiety. This may continue for years, in theory. It's madness imo.

I may be further along with this than many of you as I am in my 60s and DM is in her 90s. She has had an excellent quality of life, some health issues requiring medication but, until the last 5 years, she was very good. Over the last few years she has become frail, had several falls and health issues requiring some intervention.
DM has been very clear that she does not wish her life to be extended if the quality of it would be impaired so she will, for example, accept antibiotics for a simple infection which could be cleared with no lasting effects but she does not want any operations or treatments which would reduce her quality of life, need recovery time, etc and which could have ongoing effects. She has also declined any further investigations as she says there is no point in wasting time and resources to diagnose something you would not accept treatment for.
I accept her views and have agreed that I will observe her wishes, she has also spoken with her GP who has documented this alongside her DNR