My husband is in an advanced stage of ALZ. The NH just asked me the question if I want them to resuscitate or not. Advice?

I'm a nurse and when we have a patient who is elderly with a myriad of health issues and the family or the patient wants 'heroic efforts' we do what the family/patient wants but we call it "flogging". "Extraordinary measures" and CPR on an elderly person is the worst thing in the world to watch. I've seen good, professional nurses have to leave the room if an elderly person is being resuscitated. It's almost obscene. It's like witnessing torture. It's gruesome and horrifying to witness. The paddles cause burns to the person's chest because their skin is so thin so then you have to take care of the burns which is one more thing the person doesn't need, ribs get broken because the elderly have brittle bones so then the person will be in pain because nothing can be done about broken ribs, and if the person has dementia it will likely be worse after the resuscitation and it doesn't get better. The person doesn't bounce back.

However, we do honor family wishes and resuscitate their elderly loved one but the person they get back is not the person they had before. Personally, I don't think it's right. I think it's inhumane. And it usually has to do with the family not being able to let go as opposed to what's best for their elderly loved one.

At a certain age and in certain circumstances some families have to make the decision that enough is enough. For every blip there is a procedure or a medication or a treatment. It was that way with my dad. We decided to quit dragging him all over God's green acres for procedures that weren't helping. They didn't make him worse but they weren't beneficial either. Without them he would go down hill, we knew this, but we made the decision to let nature take it's course. Once this decision was made I called his Dr. and his Dr. told me that we had made the right decision.

Someone with advanced Alzheimer's needs to be left in peace.

OMG, I didn't even think about a pacemaker. Don't do a pacemaker if he has advanced dementia; the pacemaker will keep an AD patient alive practically forever. Please consult a geriatric doc before making any cardiac interventions. A couple of year ago, our very wise geriatric consult doctor gave me a mantra; if you're not going to do the intervention, then don't do the test. My mom had a pleural effusion and some abnormal cells were found. they wanted to do a bone marrow biopsy. She was 90 at the time (she's still with us, has had a stroke, vasc. dementia and AD). No, we were not going to do chemo or radiation if they found "something", so we were not going to put her through any invasive or painful test. Something to think about.

nerie, I know this is a shock to you. How old is your husband? If he is of advanced years, starting the heart again can be traumatic on his body. What they are probably asking you is if you want the staff to attempt cpr if he goes into cardiac arrest. If your husband is frail, cpr can cause broken ribs and possible damage due to this. If he has advanced Alzheimer's, you have a choice whether to let him cross over or to try to bring him back. The biggest question here is what would your husband want. As his proxy you want to honor what you think his wishes would be.

I made this decision for my father. I knew his life had become a burden for him and that he no longer wanted to live. I knew I was speaking for him when I told the hospital not to resuscitate if his heart stopped. He had suffered enough.

As Ba8 said, if you are not going to do the intervention then do not do the test. Almost seven years ago my mom was diagnosed with uterine cancer and she was able to still make the decision to have a hysterectomy. She was at that time forgetful, but competent. Well, after the surgery, that was when everybody started to notice significant changes in her memory and general functioning. Anesthesia can have devestating effects on an elder's brain that they may come out of but may not ever be the same. The dementia could escalate at an alarming pace as a result of the anesthesia. Mom's husband had a hip replaced three years ago now. The anesthesia effected him and afterward his cognition had decreased substantially. But after about three weeks, he snapped out of it.

I would ask myself the question, what would he want. At one point soon after I started taking care of my mom we were still able to talk about the disease of Alzheimer's in a way that she understood what was happening to her brain, that it would get worse. One night she said to me that she does not want to live that way and then actually asked me to help her leave this world. That was an extremely difficult conversation but at least it has happened only once.

Nerie, these are the most difficult decisions and you will make the right one for your husband and yourself. Thinking of you.

Something else to think about, please understand that most cardiologists will look and your husband's heart functioning in a vacuum, not as part of the bigger picture. My father in law had severe dementia and end stage kidney failure. A cardiologist thought that it eould be a dandy idea to put in a pacemaker! Just because a doctor wants to do a procedure does not mean it's a good idea.

I believe they are asking if you want a DNR do not recussitate order put in place. It would seem to be a wie option if you are comfortable with it. Is he getting palliative care or hospice? Now might be the time to look into this. Good wishes and thoughts.

I will guess the cardiologist might recommend a pacemaker. As babalou said, it will extend his life. It will not fix the Alzheimer's, and it could make it a lot worse. I don't think your husband would want to have one, it's a machine.

God, I remember how I hated signing off on my Mom's DNRs even though she was real clear she did not want resuscitated. But I did it. She did not really want to die, necessarily, but if she did she didn't want brought back, I guess. We had to decide to try a procedure called EECP for her when running out of options for bad inoperable coronary artery and borderline heart muscle function and ended up deciding she would not tolerate it. I went and looked at the facility and how it would be done and realized there was just no way, and her peripheral arterial disease was a strong relative, though not absolute, contraindication. We just had to do as much with meds (nitro, Ranexa, etc.) as we could. And feel guilty about not doing the EECP...because she did die of her heart disease not too long after that.

Just because it MIGHT help to clarify, there are some distinctions to know about. Hearts have mostly muscle that functions as an incredibly powerful, reliable pump supplying the whole body with blood (problem with this is what is meant by the term "heart failure" aka congestive heart failure, CHF, or pump failure, and if a person has cardiomyopathy, maybe compensated but not "in failure"); they have their own blood supply (coronary arteries, which can be blocked, commonly with atherosclerosis or in spasm) and an electrical system (sinus node through AV node through some right and left branch bundles to the ventricles). Sometimes just one of those things is messed up, though each can tend to mess up the others, e.g. a heart attack or myocardial infarction usually does not take out so much heart muscle that it fails as a pump, but an arrhythmia can be caused that goes into "v tach" or "v fib" and causes sudden death. An implanted defibrillator essentially resuscitates someone automatically if they arrest when that happens. A pacemaker does not give you palpable shocks per se, it just mantains a heart rate and rhythm if the heart's own electrical system is out of whack - pretty common in older folks, you may hear it called "sick sinus syndrome" or "heart block" and the heart muscle and coronary arteries may be just fine, but the heart beat is too slow or irregular. Having a pacemaker may improve quality and length of life substantially, but won't keep you alive if something other than heart rhythm goes badly awry, e.g. a heart attack (coronary artery occlusion) or heart muscle weakness (heart failure), or something non-cardiac such as sepsis, which is what my dad died from, with his pacemaker in place and working fine.

So, clarify with the cardiologist what is meant by "heart blockage" and go on from there. It is not always easy to decide what treatments will be good for a person in terms of living and feeling better, versus what is just a burden and not worth it. There are times when resuscitation works and gives people some frosting on their cake so to speak - or even a much bigger piece of cake! - but in severe and advanced dementia, that's probably not the case. And just because you say DNR does not mean you can't have other medical interventions that you think would be good, like oral or IV antibiotics, or medicine, or breathing help at night with whatever might be tolerated. And just because any medical procedure could be done and might extend life a little, it does not have to be done if the person is going to hate and fight it too much, or you have every reason to believe longer life is no longer a blessing for the person living it. It can be OK to let go. I say that with a little hesitation, because we know there are times that longer life for the person would be a gift but perhaps a very expensive gift, and the system may be starting to lean even more towards withholding care that might be very appropriate and desirable, just because of a person's age or disability.

So the caveat I have today is to be well informed...I was sure flustered when my cousins and BIL discussed deciding for my MIL that she should not have a feeding tube "because then she could not talk and would be tied down in bed" - actually it was the right decision, but wrong reason in the that case. And you would not want someone to say "no ventilator or artificial feeding" thinking they are just not wanting to be in an immobile or vegetative state, because if they were otherwise enjoying a good life but due to a more unusual medical condition simply became unable to swallow or take deep enough breaths all day and all night, whether temporarily or permanently, then they would lose out.
This is one of those things where you have to get your head and heart together and make the best, most loving decisions that you can, and the more you also know about what your loved one wants and doesn't want in advance, the better.

Thanks you all that answered my question. Each one contains very valuable information and I already signed the DNR. God Bless You All...hugs...

Nerie: Be well and I hope that all goes well with your husband. Hugs and love from Brooklyn.