Not having medical procedures in old age

[Orangesandlemons77]

I should possibly post this in AIBU, but thought those here might understand what I'm on about.

I'm in the age of having parents and neighbours getting old and seeing a pattern emerge.

They seem to get treatments / surgery to prolong their life but this seems to not bring a good quality of life.

For example, one has vascular dementia, but recently had a heart problem and got a pacemaker fitted. If this had not happened I think they would have died of heart failure, but now they might go on for years getting slowly worse mentally. How they decide to turn it off I don't know.

Another similarly has the same dementia but had a heart valve replacement surgery and that os now keeping them going.

My elderly dad has mixed dementia and recently suffered with pneumonia which used to be called the 'old mans friend' he was treated with antibiotics and now recovered but struggling with UTIs and confusion.

I had genetic testing and have a copy of the APOE4 gene meaning I have a slightly higher risk of alzheimers and maybe this is focusing me on this as well.

I am considering doing an advance statement stating no life saving treatments / surgery after say 75. I'm also doing a PoA as well. I already have a problem with the bowel which can result in obstruction (adhesions) so that might see me off before the dementia kicks in.

Sorry if this sounds morbid but I wondered if this resonates with anyone else.

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!

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.

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.

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 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...

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 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 😁

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

Thanks for this, it is useful to know more about pacemakers and quality of life.

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.

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.

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.

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.

@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.

@sashh thank you, I didn’t know that!

I used to do that job.

Pacemakers come in a range from very simple to having all sorts of sensors so they react to activity so if you go for a run the PM will increase your heart rate.

You can also turn the basic pacing rate up and down.

No one wants a 96 year old to go through a procedure no matter how simple if they can do something else.

Getting a pacemaker, to me, is like choosing a pair of shoes and you can only wear those shoes for the next 5 years.

If you are an athlete you probably want shoes you can do your sport in, but for an older person who is not particularly active then a pair of slippers will do.

The main things that can be changed for each lead (most basic only have one lead) are the voltage, the duration and the rate.

I remembered this post as my dad is in a nursing home, over 80 and with dementia. Brother has PoA, anyway the nursing home asked about if dad should have a DNR in place and would he want or refuse hospital treatment.

Brother wants dad to have 'all the help he can get" so no to the DNR and yes to hospital treatment, does not feel can discuss it with dad either.

I'm not happy really but I am not the one with PoA.

Again made me think I must discuss this and put my feelings in place for myself, it can cause problems if family are just left to make the decisions.

Sorry to hear that.

I feel your instincts are the kinder ones really and your brother is just in denial about your Dads quality of life. Still, you have to accept it as you say which must be hard.

Thanks, it seemed to be around the idea of 'doing everything we can'.

I haven’t fully read the thread yet but could be facing this situation with 87 year old DM. She has a neurological condition causing mobility issues, incontinence and mild dementia. It could potentially be resolved or least improved with a shunt but that’s brain surgery.
Heart, lungs, kidneys etc all in fine working order but she is frail, mainly because of the mobility issues.

I suspect that the doctors will decide not to operate but how do you make that decision?

In her current condition she could live for years albeit in danger of falling and potentially fracturing something, live a half life because her memory is shit and her mobility worse, paying for care, possibly needing a care home.
Or go through brain surgery with all the attendant risks but potentially be more mobile and know what’s going on and have a better quality of life.

Do you have PoA? Could do an advance decision. See upthread there is a link. I guess the surgeons would discuss with you and your mum.

Would she be able to discuss with you and give her thoughts on it? It's so hard isn't it all of this.

We do have POA, yes. I’m trying to arm myself with all the arguments for and against before we see the neurologist.
Unfortunately her short term memory is awful so I’m not sure she’s following what’s going on.

Yes same with my dad, very difficult, I feel for you.

Ultimately the doctors will decide. You can’t force them to operate if they do decide it will cause harm with no benefit.

if her dementia is mild and in the moment she understands the conversation and the consequences of the surgery, it will be her decision. Even if she can’t remember that conversation in a couple of hours. For a health and welfare POA to be invoked they need to be unconscious/at a point where they can’t understand the conversation.

FWIW in your situation I think I’d take the option for a better quality of life and have the surgery. To me the prospect of a longer life with no independence and deteriorating awareness is not something I’d want to be around for, and I’d rather risk the surgery.

Thank you @Whycanineverthinkofone That is my thinking too, I’d like her to have the surgery but as you say, the doctors will decide. We are waiting to see the neurologist.