My 88 year old Mom who lives with me and my husband has had coronary artery disease for years. In the past she's had a triple bypass and three stents, as well as a pacemaker. Then the dementia came. Slowly at first, but she is well into now, with a memory span of about 5 minutes. She has a very sweet disposition. Medicine has kept all of the heart problems at bay for a long time. All of a sudden it's back....the chest pains....unstable angina. Tests have revealed she has another blockage, and the cardiologist wants to do an angiogram and most likely an angioplasty. I am doubtful she would survive these procedures, as she is quite frail. And another worry is that it may likely set her dementia further along. She has just spent a night (last night) at the hospital as a result of pain that couldn't be alleviated with the Nitro, that has been working up until last night. The hospitalist we conferred with last night said that this would be happening more and more now, and if we are not going to take the next intervention step with the heart procedures, we should enlist the services of Hospice vs: trips to the hospital. He seemed to question what good would it do to subject my Mom to these invasive procedures which may make things better (or NOT) to live a quality of life that is diminishing and only to get worse and worse. I'm in a quandary about this. Do I have her heart problem fixed? Could she be worse off in the dementia scenario as a result? Or she could die even from the procedures which have their risks. Or do I call in Hospice and keep things as comfortable and decent as possible until her heart gives up? What would you do? (I spoke w/ Mom early this morning at the hospital, and she's as confused as ever just from this one brief thing. That's why I worry about all of the stuff involved with surgical procedures, anesthesia, etc.)
I'm sure your presence with her provided a great deal of comfort in her last hours.
My mom has a living will and DNR which she completed when she was competent. She would not want to continue to live if she understood the effect Alzheimer's has taken on her brain. A few years ago she wanted me to help her die. This was when she understood, somewhat, what was happening to her.
My thoughts are to bring in hospice and let nature take its course.
Taking her age and the dementia into consideration it's my opinion that your mom will come out of the procedures worse than when she went in. The anesthesia alone with exacerbate the dementia and most likely your mom will never fully bounce back.
Surgery at your mom's age with her dementia is very aggressive treatment and you and your family need to decide what your mom would want and what's best for her in the long run. I think hospice should be seriously considered and I think it was appropriate for the Dr. to suggest it.
If my father wasn't able to get the fractured hip repaired, he would be bedridden for the rest of his life. And we all agreed that would not be the kind of life he wanted.
I knew that there were risks to the surgery, but if my father didn't survive it, at least he would be spared the indignity and misery of living a bedridden life; Dad and I both knew he would decline rapidly and spent his remaining life depressed and miserable.
Almost one year later, he's successfully recovered from the fracture and is walking without a walker. (He also had a pacemaker replacement a few years ago and faced similar cardiac issues then and still does.)
I feel for your pain and dilemma - you're really between a rock and a hard place. These are decisionos which no one should have to make, but unfortunately, we do face them.
This is the way I would see it: the surgery may be successful but may advance the dementia. Would you be comfortable with that outcome, i.e., more stable cardiac health but more challenging mental issues?
And, most importantly, what do you think your mother would want? Are you her sole caregiver? Are there siblings involved with whom you would want to consult?
I've dealt with dementia but probably not as much as most people here, so it's hard to put in perspective what your mother's quality of life is now, although it doesn't seem good.
I would actually risk the surgery, assuming I was prepared to care for her either at home or at a facility. I had to sign the DNR order for my sister and it was an act of mercy but I still feel uncomfortable about having done so.
Honestly, and I don't hope I sound callous, I would opt for the surgery, if your cardiologist (not the hospitalist) gives a reasonable chance of success. But I would also balance that with whether or not you could continue to care for her at home or whether you would need to consider a placement, which would probably be more challenging mentally for her.
Wish I could offer some better advice but this is such a difficult, and personal situation, and I think really turns on what your mother would want.
I hope you're able to find peace with whatever solution you choose, and know that you've done the best for your mother.
IMO this is the reason why my Mom has a "Living will". We discussed this when she made me POA and she did not have dementia.
If you want to know what I would do then I would not have surgery.. I know it's a tough decision but she needs you to be brave for her..She entrusted you with her wishes..
Whatever you decide I will be thinking of you and Mom.
Best wishes my AC friend...