Congestive heart failure in 90 year old - any experience?

[Noitsnotteatimeyet]

It looks like my elderly father has congestive heart failure - he's short of breath, has terrible lymphodoema so his feet and ankles are swollen and v sore. His GP has rung to say he wants to discuss the results of his blood tests next week as they are indicative of CHF.

He's very frail, has limited mobility, is extremely hard of hearing and has started to develop problems with short term memory. He's lived on his own since my mum died 2.5 years ago - she was much younger than him and had been his carer for years. His flat is on the ground floor and has as many adaptations as we can think of. He has visits from his neighbours, me and my sisters and his cleaner comes in several times a week but he's still isolated and depressed. He seems to have lost interest in everything he used to love and sleeps for much of the day. Earlier this year he collapsed with bradycardia and had a pacemaker fitted.

Does anyone have any experience of a similar situation - how long might we be looking at? It all seems v depressing at the moment as he's declining slowly but inexorably

Hello, it does sound difficult. I do not have personal experience of CHF but I know form working in hospitals (as a dietitian) that heart failure can be notoriously hard to prognosticate. I would definitely have that conversation with the GP. As depression is a big feature of your Dad's difficulties, is he on an anti depressant?

Impossible to give a prognosis. Depends on too many variables. If he has good kidney function he could cope well with meds for a long while. If he has significant renal impairment like my mum did it is much harder to treat.

However, he is 90 and has multiple things wrong. You need to be aware that heart failure has a much lower 5yr survival than many cancers ( and that's at any age ).

You might need to have hard talking chats with the GP and your dad about how intensively he wants to be treated- and as a result some really good " dad centred" advanced care planning can happen. do that soon. he could choose intensive treatment and that could be provided f he tolerates it, but at 90 and frail he may well decide to take a palliative course. With non cancer diagnoses it can be harder to get palliative support but is gettin much better.

Much hugs. PM me if I can help with any questions.

Thank you

He can't cope with the amount of medication he currently has and is about to get a whole load more for the heart failure so I'm loathe to add any more. To be honest I think he's checking out - he doesn't have anything to look forward to and his beloved cat is also terminally ill.

I was with him when he collapsed earlier this year with bradycardia and at first I thought he was having a stroke - part of me thought that it wouldn't have been the worst thing that could have happened to him

I really feel for you my dad has lived with heart failure for many years now and has coped remarkably well. He was admitted to hospital earlier this year. A chest infection had worsened his heart condition. He's 82 and seems to have aged and slowed rapidly in the last few months. I feel pretty helpless.

Op I can so identify with " a big strike wouldn't be the worst thing to happen" I really can.

Poppy please don't feel helpless. Helping someone plan how they want their life to be lived through their last months / years is vital and it's something you can steer them towards thinking / talking about. There is always " help" to give, even if it's not curing or even life prolonging. Life enhancing is always possible - from yo fancy a cream cake, let's get one then, to let's go to the ballet whilst we can.

DDad has just, this week, been diagnosed with CHF - horribly breathless, really low oxygen levels, weakness etc. He is currently in hospital and has been on serious oxygen for periods of the last couple of days. We had THE conversation with the doctor yesterday and he told us prognosis is very difficult. Dad's kidneys are luckily in good shape which gives them a few options, but he also has low level dementia, high blood pressure and just other general stuff relating to old age.

My dad loves (loved) his life, but will not like being hospitalised for any length of time while this is sorted and we're really worried he'll just give up. My eyes keep leaking because I feel so helpless, and I think we're wobbling on the side of quality rather than quantity, and I can hardly bear it.

Sorry to hear that yonkers- how old is your dad?

Mine is not too bad at the moment, touch wood. We had a long chat with the GP who's just put him on furosemide to help reduce the build-up of fluid in his feet/ankles. He's reluctant to start him on anything else as the standard medication can cause problems with cognition and memory and we certainly don't need that ...

The GP said he couldn't give a detailed prognosis but that elderly patients with heart failure did tend to bounce in and out of hospital which my dad would hate

I've sent you a PM, OP.

My Mum had this - swollen ankles and legs, hospitalisations for breathing problems. She was younger than your Dad but had Type II diabetes and was very overweight.

What happened with her, and I think it's not unusual... something, often an infection, would trigger breathing problems and she'd be put on diuretics and often hauled into hospital for a week or so. Then they'd buff her up and she'd be out again.
The local heart nurse would visit her at home and helped keep her out of hospital as much as possible.
The leg swelling ended up with diabetic leg ulcers which had to be redressed all the time - district nurse and GP surgery nurse helped with that. An attempt to sort the ulcers with compression bandages backfired as it shifted the fluid to her lungs.
The last two months of her life were in hospital where they tried to treat the infections, keep her heart and lungs going BUT the diuretics buggered her kidneys in the end. Failing kidneys result in problems with electrolyte balance which result in the heart not beating as it should and in the end her heart stopped.
I had worried that breathing issues would be the end which is not a nice way to go but that didn't happen.

Um practical advice?

Having healthcare LPA was helpful in getting people to talk to us. Get that sorted if you can.

She had an Advanced Care Directive done and we were instructed to be heavy on quality of life. That might not matter so much when healthcare resources are really stretched like now but in quieter times...

The heart nurse was great - see if your healthcare lot offers similar.

You can have home oxygen set up (and Mum did have this very briefly).

If he's on diuretics at home make sure he has a bedpan or bottle close so he doesn't have to worry about getting to the loo (advantage of being a man).

Spend time with him - at least the little comforts and the company will help. Have the conversations you need to have, bring out the old photos, get the stories told, tell h your plans for the future, and have no shame about feeding him a diet of cream cakes and amusing kitten videos if that helps at all.

It was a few years of bouncing in and out of hospital - 2-3 - but she was younger (and no covid-19).

Hope that helped a bit. I remember how at sea I was.