Fainting/ER/Pacemaker

Wilted Daughter

89 year old mom with history of fainting (low/high blood pressure, diabetes...) fainted and hit her head yesterday. She was taken to the ER by ambulance and admitted to the Critical Care Unit overnight for observation and possible scheduling of pacemaker.

I sent her PCP a message stating my concerns (pros/cons of pacemaker, ongoing medicine management, previous/current need for visiting nurse, OT and PT.  Main concern is that a pacemaker will be inserted without complete consideration of other factors that may attribute to fainting thus adding another medical condition to manage. 

It would be helpful for mom to stay either in the hospital or rehab facility for a few days until such time a beneficial plan of action for future/home care is created. I have applied for Medicaid in April this year and a decision has yet to be made, perhaps this hospitalization will result in  Medicaid approval and allow for the necessary assistance/services. 

IDK what to expect...has anyone had a similar experience? 

LicketyGlitz

I have not been through this, Wilted, except for the part of convincing a hospital to keep Mom for a couple of extra days after she fell and broke her hip at a friends house. We still didn't have power at our home (this was during an ice storm in February).

One suggestion... is she potentially ready for hospice? They might be a big help in navigating this interim housing period, and helping you identify meds better than her PCP if they are not super familiar with end of life issues.

Good luck to you and your mom.

Jimbob59

I would instruct the hospital to not even consider a pacemaker for an 89 year old PWD. What is the expected outcome? a few more years of life so she can reach stage 7.

loveskitties

Do you have medical power of attorney?  Does she have an advanced health care directive?

The PCP might be contacted by the hospital, but is surely not the one to do surgery.  It would seem to me that before any extreme procedure she/you would be consulted about do it/not do it.

There might be a patient advocate at the hospital who could help advise you based on her status and your concerns.

Hope you find the help you need

harshedbuzz

Wilted Daughter-

I do not know that I have it in me to sign off on a pacemaker for an elderly person with dementia much past stage 3.

I would not want to be in a position to be the person making the choice to deactivate the device.

Cardiac Pacemakers at End-of-Life - Palliative Care Network of Wisconsin (mypcnow.org)

HB

Cynbar

If she stays in the hospital for a minimum of 3 nights, she should be able to go to a facility for short term rehab which Medicare would pay for.  The time she could be there will depend on how much progress she can make with therapy to increase her strength, but this will buy you some time. Ask to speak to a discharge planner at the hospital and request this option (there is no downside other than adding another move for her.) The doctor has to order rehab (they are usually happy to do this, again no downside) and then the discharge planner will look around for a bed.  Try to choose a facility that also offers long term care, then the social worker there can try to facilitate the Medicaid approval.

M1

Tough dilemma. I’d be loathe to Put a pacemaker in too, but if she’s still ambulatory, passing out could mean a painful fracture. If she’s already bed or wheelchair bound, I wouldn’t do it.

Wilted Daughter

When mom fainted on 8/10/21 she went to the ER and admitted that evening to Critical Care. Since she is ambulatory and prone to fainting the pacemaker is said to help with slow heart beat issues. The 30 mins. procedure was performed on 8/11/21 and I spoke with a case manager  before surgery to arrange recovery plan and rehabilitation. Spoke with the hospital PTs yesterday who agreed with rehabilitation (mom's frail but can walk), she will need a walker now instead of a cane. The pacemaker is expected to help with the heart issues, but not low blood pressure and medicines which may contribute to her fainting. All I know is the fainting has to be controlled and no one has ever said before now anything about her heart. She's had fainting spells for most of her life. 

I don't know when she will be released/transferred from the hospital as she is still in recovery, but she looked much better yesterday than days before she went to the ER. My task now is to move her bedroom downstairs and arrange the house accordingly for her arrival. The Medicaid issue will work itself out (I'm tired of the back and forth with them). 

Thank you all for your responses. Stay safe, well!