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My dad is 88 with CHF, CKD and ALZ. His recent doctor visit revealed a BP of 80/40. His BP meds have been discontinued, but he only took a tiny amount. Hospice wasn’t discussed, but I wonder if we should. His appetite is still good. Sleep has increased quite a bit. Cognition varies, but is substantially worse lately.


Has anyone seen vitals like that and how did it go? We are deciding on POLST preferences now, based on his Living Will.

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Sunnygirl1: My mother's plummeting blood pressure (60 over 40) was the reason why I had to move in with her from out of state. Before that she was a legally blind woman demanding to live alone. Obtain a home blood pressure cuff.
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Sunny girl, has the cardiologist put dad on potassium supplements with the water pills? If not, you need to ask about it right away.

My dad was on Lasix in NV, moved to AZ and his new cardiologist was horrified that the current doc wasn't monitoring his electrolytes, especially the potassium. My dad did way better getting these levels brought up. He didn't need BP meds anymore as a result of this.
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Sunnygirl1 Mar 2, 2025
Isthisrealyreal,
He wasn’t up to continue the 2 hour trip to the out of town cardiologist, so pc is monitoring. His last recent potassium was normal and his labs are good, except his kidney decline. He has afib too, that used to be controlled with meds. Cardioversion worked at one time as well. We are really honoring his request for comfort care now. He has no patience for hospitals. We understand the reality.
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My dad had been on blood pressure meds for a few years in his 70s. His last year, blood pressure was dropping really low at times, and he did have dizzy spells when standing up, would see flashing lights, started to fall and/or have to feel his way along, etc. He had dementia and cancer and kidney failure. He rarely drank anywhere near healthy amounts of fluid — getting him to drink 8 oz per day was near impossible. He hated it and found swallowing difficult. ThickIt did not help him. He was also eating very little, and only ice cream. Twice when he went to the hospital for a day or two, they had him on intravenous fluids and his cognition, awareness, and engaging in speaking increased dramatically. It was gratifying and unusual for me to get responses out of him though he disliked having to urinate so much more often.

Anyway. His geriatrician stopped the BP meds. Shortly thereafter, dad went on home hospice. The nurse would visit and measure BP once per week. Usually it was quite low, but sometimes near normal and this was an indication of a good day.
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Reply to Suzy23
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Don't worry about BP unless symptomatic. Dizziness, especially on positional change getting up from bed or from sitting is the most important thing to begin to watch for. As an old retired RN I can assure you WAY too many people are on WAY too many drugs and the BP meds the worst culprits of all. They truly are handed out like candy and most people have enough "white coat phobia" to have high BP when measured by the MD. When they get home it goes down again. When I was RN on cardiology that's our most common cause of collapsed people of an age entering care.

I recommend no wrist devices or finger devices for measurement, only arm. Omron makes the best measurement devices which are now about 45.00 on Amazon. Take BP and record daily before medications. Always ask MDs what measurements BP meds should be "held" for (not taken).

When BP measures too low a big glass of water will help blood volume rise and repeat measurement in about an hour. Be sure senior with low BP doesn't become dehydrated.

Other than this, report changes to the doc. Good luck. You will find some people esp as they age have a more "labile" BP, or more "changeable". Normal for elders to a certain extent.
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Sunnygirl1 Mar 2, 2025
Alvadeer,

What numbers can a senior likely encounter long term once they reach 80/40.? I realize you have no crystal ball…..just wondering if he will continue with that 80/40 for the near future. Do many heart patients live with that? I’ve read the organs aren’t getting proper blood flow.

I may need to arrange for wheelchair use in the house. He uses transport chair when we go out. He’s been using rollator in the house. He does well drinking fluids through the day.
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My dad had a very long road with CHF. Many rounds of hospitalization to pull off fluid that oral Lasix wouldn’t touch. IV Lasix is a far different, far more effective med but requires hospitalization to monitor electrolytes as things can get out of balance and dehydration can happen quickly. He also had low blood pressure after formerly being on meds for it being high. Dad had endless falls due to leg weakness, thankfully never breaking a bone. He definitely slept more. He never had dementia and ultimately he chose home hospice for himself. He was exhausted and was ready to leave this world. His appetite remained until the last week of his life. It was impossibly hard to watch, I often just held his hand and told him I understood his desire to leave. After choosing hospice, we were told he’d likely live about 5-6 months. He was gone in 7 weeks. CHF is a slow, insidious disease. I wish you the best in finding the best plan
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Sunnygirl1 Mar 2, 2025
Daughter1930,
How do you know when there’s fluid? His doctor stopped the fluid pill he was taking 3 days a week.

After Hospice your dad passed away in 7 weeks. Was there anything in particular that brought that about or it was just the normal course of his CHF? Did he continue any meds after Hospice, like statin, blood thinners, heart med for Afib, etc?
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Good points you both make. I’m meeting with my siblings tomorrow to discuss the situation. We’ll see how things go today.

My dad is 25 years post quadruple bypass and multiple stents. His relatively good health over all those years is amazing, but the last few have been rough. Very poor quality of life now. I appreciate the input based on your experiences.

He has had multiple falls due to weakness. He usually just folds down on the floor. No hard falls or fractures thank goodness.
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Sunny, my mom passed from CHF in 2020 and also had very low blood pressure. It would also drop while she was sleeping. We had to be very careful when she would first get up and try to stand, because the very low pressure caused her to be dizzy, which led to falls. 80/40 was not uncommon for my mother.

I think you should discuss hospice care with mom's doctor. My mother's cardiologist was reluctant to bring it up because he didn't want to be seen as "giving up" on her. That might be why your mom's doctor hasn't discussed it yet. But hospice was a great help to her and to us, and made her final days pain-and-anxiety free for her, which is all you can really hope for.

Good luck. I know how hard this is, and my prayers are with you.
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Recently my 105-yr old Aunt had symptoms of CHF, and confusion was one of them, along with fatigue/panting and weeping, cold, legs. She went to the ER and came home with a diuretic and 2 pills for her heart. Her confusion cleared up completely but then within the same week she had a paralyzing stroke before I could get her assessed for hospice. But eventually she was assessed for in-home hospice and she passed peacefully at home a few days later.

I would do the hospice right away, since your Dad has other profound health problems as well. My Aunt had no other health issues, not even cognitive or memory issues -- just a very very worn out heart.

I wish you wisdom and peace in your heart as you make decisions.
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