Skip to main content
SpringerLink
Log in

How Age Matters: The Emotional Work of Younger and Older People Living with Defibrillators

  • Chapter
  • First Online:
Book cover Resilient Cyborgs

Part of the book series: Health, Technology and Society ((HTE))

  • 340 Accesses

Abstract

This chapter addresses the emotional distress that may emerge when bodies are implanted with heart-rhythm devices. To avoid the pitfall of framing emotional distress as an inherent characteristic of individuals, I suggest it is important to take into account the different reasons why people receive defibrillators in the first place, particularly age-related differences. Whereas many older people are more likely to receive an ICD for the treatment of heart failure or to prevent sudden cardiac arrest, young people may receive these implants because of genetic predispositions of life-threatening heart-rhythm disturbances. These age- and disease-related differences are important to take into account because the appropriation of technologically transformed bodies may involve very different kinds of sensory experiences. Conceptualizing emotional distress as a technology- and disease-mediated process rather than an individual trait, this chapter explores the emotional work younger and older people invest in reducing the anxieties co-produced by their devices and illnesses. The chapter shows important age-related differences in the ways in which wired heart cyborgs try to become emotionally resilient cyborgs, including differences in the emotional work invested in coping with their anxieties and the social resources available for building emotional resilience.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 99.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Notes

  1. 1.

    Psychological research on emotional distress thus differs from psychological studies of resilience in which the concept of resilience as a fixed personal trait has been replaced with a perspective that considers resilience as a multi-faceted process. See Chap. 2 for a more detailed description of this conceptual change in psychological research.

  2. 2.

    This does not imply that young people are not at risk of SCA or heart failure, but these disorders occur more frequently among the elderly.

  3. 3.

    For privacy reasons, I have used fictional names to refer to these three interviewees.

  4. 4.

    Cardio-genetic research following a young person’s sudden death involves genetic screening in the whole family tree, which may result in the detection of tens of carriers of the genetic heart disease (van den Broek 2012). Theoretically, the diagnosis of a genetic heart disorder implies that approximately 50% of direct family members run the risk of getting the same disease with a chance of sudden death. In practice, this risk is much smaller because most inherited diseases don’t express themselves. Therefore, many family members will not experience any heart problems (Wilde 2007, 4).

  5. 5.

    www.en.ecgpedia.org. Accessed 17 July 2017.

  6. 6.

    See Chap. 3 for a detailed description and analysis of what happens during the control visits at the cardiology policlinic.

  7. 7.

    Dutch and other European laws do not allow people living with ICDs to become professional truck drivers (Anonymous 2013).

  8. 8.

    In hospital, SCA occurs in an additional 209,000 cases (Kronick et al. 2015).

  9. 9.

    In the US, the incidence of out-of-hospital SCA per 10,000 adults is 10.1 among Blacks, 6.5 among Hispanics, and 5.8 among Whites (Sudden Cardiac Arrest Foundation 2015).

  10. 10.

    The causes underlying these abnormalities include a heart attack, a thickening of the heart muscle, heart-rhythm and heart-valve disorders, and recreational drug use (Anonymous 2010).

  11. 11.

    This treatment should be delivered within 3–5 minutes after collapse to avoid oxygen shortage in the brain. AEDs are devices very similar to ICDs but are not implanted in bodies. They are portable electronic devices that give an electric shock to restore a normal heart rhythm and are explicitly designed for use by laypeople. If resuscitation is performed effectively and followed by treatment with an AED, the survival chances of SCA victims increase from 6% to 74% (Anonymous 2012).

  12. 12.

    Because this interview took place just before Nancy visited the cardio-genetic clinic, the test results were still unknown during the interview.

  13. 13.

    In the psychological literature, 50% of SCA survivors have been diagnosed with some type of major depression, adjustment disorder, or panic disorder (Dougherty 2001).

  14. 14.

    Magyar-Russell (2012).

  15. 15.

    Although historians of technology have described how people sometimes consider technology as the work of God, Nancy did not include this kind of consideration in her religious struggle. See David Nye, for example, who has described how Americans considered the steam engine, when it was first introduced in the US, as a direct work of God (Nye 1994, 57–58).

  16. 16.

    In the instructions provided by hospitals and patient organizations, ICD and pacemaker users are told that they should no longer engage in deep-sea diving and full-body contact sports (Anonymous 2015).

  17. 17.

    In the US, the number of months in which ICD users are forbidden to drive after a shock varies from two to four months (American College of Cardiology 2011). People implanted with an ICD also require a fitness certificate from the cardiologist, and the commercial drivers’ licenses of truck, bus, or taxi drivers are no longer granted (STIN website Rijbewijzen. https://www.stin.nl. Accessed 3 August 2017).

  18. 18.

    Interview, chair of the Dutch patient organization STIN 2012.

  19. 19.

    According to the medical literature, cardiac resynchronization therapy (CRT) is only effective in improving the heart pumping function and decreasing shortness of breath and exertion in 50–70% of patients implanted with these devices (Albouaini et al. 2007). Treatment with the multifunctional ICD reduced the one-year mortality to less than 10% (Taborsky and Kautzer 2014, e66). Although medical experts agree that CRT contributes to preventing death, the normalization of this cardiac treatment in older people has been controversial and the subject of lively debate in the medical literature. Because people above 75 years old have not been included in clinical trials to examine the effects of the ICD/CRT, cardiologists have criticized the promises of CRT. More recent research has focused on which elderly patients might benefit most from ICD implants (Taborsky and Kautzer 2014; Young et al. 2013).

  20. 20.

    See Chaps. 3 and 4 for the challenges involved in adjusting ICDs.

Bibliography

  • ABC news. (2011, May 5). http://abcnews.go.com/health/doctors-implant-defibrillator-family-genetic-heart-conditions/story?id=13529748. Accessed 4 Aug 2015.

  • Albouaini, K., et al. (2007). Cardiac resynchronization therapy: Evidence-based benefits and patient selection. European Journal of Internal Medicine, 19, 165–172.

    Article  Google Scholar 

  • Almeling, R., & Willey, I. L. (2017). Same medicine, different reasons: Comparing women’s bodily experiences of producing eggs for pregnany or for profit. Social Science & Medicine, 188, 21–29.

    Google Scholar 

  • American College of Cardiology. (2011). Driving driving restriction guidelines for patients with implantable cardioverter defibrillators. Find out which patients with ICDs shouldn’t drive within 2–4 months of their last shock. CardioSmart. News & Events. https://www.cardiosmart.org/News-and-Events/2011/06/Driving-Restriction-Guidelines-for-Patients-with-Implantable-Cardioverter-Defibrillators. Accessed 3 Aug 2017.

  • Anonymous. (2010). Pacemakers: The new generation. Today’s implantable units do far more than previous models. Cleveland Clinics.

    Google Scholar 

  • Anonymous. (2011, January). Misschien hebben we in de toekomst wel geen ICD meer nodig. Stin Journaal. http://www.sidned.nl. Accessed 3 July 2017.

  • Anonymous. (2013). Code 1010 en de bedoeling van de wetgever. STIN Journaal, 1, 33.

    Google Scholar 

  • Anonymous. (2015). Informatie voor patiënten. Een ICD. Wilhelmina Ziekenhuis Assen. https://www.wza.nl/media/610853/cardi20_-_juni_2015.pdf. Accessed 7 Aug 2017.

  • Berul, C. I., et al. (2008). Results of a multicenter retrospective implantable cardioverter-defibrillator registry of pediatric and congenital heart disease patients. Journal of the American College of Cardiology, 51, 1685–1691.

    Article  Google Scholar 

  • Bifulco, P., et al. (2014). Frequent home monitoring of ICD is effective to prevent inappropriate defibrillator shock delivery. Case Reports in Medicine: 579526.

    Google Scholar 

  • Bilge, A. K., et al. (2006). Depression and anxiety status of patients with implantable cardioverter defibrillator and precipitating factors. Pacing Clinical Electrophysiology, 29, 619–626.

    Article  Google Scholar 

  • Charmaz, K. (1991). Good days, bad days: The self in chronic illness and time. New Brunswick: Rutgers University Press.

    Google Scholar 

  • Cleveland Clinic. (2010). Biventricular pacemaker. https://my.clevelandclinic.org/health/treatments/16784-biventricular-pacemaker. Accessed 4 Aug 2015.

  • Conley, M. (2011). New defibrillators keep 5 family members from cardiac arrest.

    Google Scholar 

  • deWitt, E. S., et al. (2014). Time dependence of risks and benefits in pediatric primary prevention implantable cardioverter-defibrillator therapy. Circulation, Arrhythmia and Electrophysiology, 7, 1057–1063.

    Article  Google Scholar 

  • Dickstein, K., et al. (2008). ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008: The task force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association of the ESC (HFA) and endorsed by the European Society of Intensive Care (ESICM). European Heart Journal, 29, 2388–2442.

    Article  Google Scholar 

  • Diez-Villanueva, P., & Alfonso, F. (2016). Heart failure in the elderly. Journal of Geriatric Cardiology, 13(2), 115–117.

    Google Scholar 

  • Dougherty, C. M. (2001). The natural history of recovery following sudden cardiac arrest and internal cardioverter-defibrillator implantation. Progress in Cardiovascular Nursing, 16(4), 163–168.

    Article  Google Scholar 

  • Fuchs, V. R. (1968). The growing demand for medical care. New England Journal of Medicine, 279(4), 190–195.

    Article  Google Scholar 

  • Go, A. S., et al. (2013). Executive summary: Heart disease and stroke statistics – 2013 update. A report from the American Heart Association. Circulation, 127, 143–152.

    Article  Google Scholar 

  • Goldstein, N. E., & Lynn, J. (2006). Trajectory of end-stage heart failure: The influence of technology and implications for policy change. Perspectives in Biology and Medicine, 49(1), 10–18.

    Article  Google Scholar 

  • Hinke, B. (2017, July 10). Hartritme stoornissen van ‘Appie’ houden Ajax in onzekerheid. NRC, p. 5.

    Google Scholar 

  • Jeffrey, K. (2001). Machines in our hearts: The cardiac pacemaker, the implantable defibrillator, and American health care. Baltimore: Johns Hopkins University Press.

    Google Scholar 

  • Kaufman, S. R., Mueller, P. S., Ottenberg, A. L., & Koenig, B. A. (2011). Ironic technology: Old age and the implantable cardioverter defibrillator in US health care. Social Science and Medicine, 72(1), 6–14.

    Article  Google Scholar 

  • Kronick, S. L., et al. (2015). Part 4: Systems of care and continuous quality improvement. American heart association guidelines update for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation, 132(18 Suppl 2), S397–S413.

    Article  Google Scholar 

  • Krumholz, H. M., et al. (2005). Report of the National Heart, Lung, and Blood Institute working group on outcomes research in cardiovascular disease. Circulation, 111, 3158–3166.

    Article  Google Scholar 

  • Latour, B., & Venn, C. (2002). Morality and technology: The end of the means. Theory, Culture and Society, 19(5/6), 247–260.

    Article  Google Scholar 

  • Magyar-Russell, G. (2012). Religious and spiritual issues among cardiac patients: Dilemmas faced by implantable cardioverter defibrillators (ICD) recipients. Newsletter of the Society for the Psychology of Religion and Spirituality. American Psychological Association Division, 36(1), 1–2.

    Google Scholar 

  • Montfort, A. P. W. P., & Helm, M. H. J. (2006). Telemonitoring of patients with chronic heart failure. Disease Management & Health Outcomes, 14(1), 33–35.

    Google Scholar 

  • Nieuwenhuis, H. (2017). Een erfelijke aandoening kan heftige emoties oproepen. STIN Journaal, 2, 6–8.

    Google Scholar 

  • Nye, D. (1994). The American technological sublime. Cambridge, MA: MIT Press.

    Google Scholar 

  • Olde Nordkamp, L. R. A., et al. (2013). The ICD for primary prevention in patients with inherited cardiac disease. Indications, use and outcome: A comparison with secondary prevention. Circulation, Arrhythmia and Electrophysiology, 6, 91–100.

    Article  Google Scholar 

  • Oudshoorn, N. (2011). Telecare technologies and the transformation of health care. Houndmills/Basingstoke/Hampshire: Palgrave Macmillan.

    Book  Google Scholar 

  • Pedersen, S., & Denollet, J. (2006). Is Type D personality there to stay? Emerging evidence across cardiovascular disease patient groups. Current Cardiology Review, 2, 205–213.

    Article  Google Scholar 

  • Pedersen, S., et al. (2008). Clustering of device-related concerns and Type D personality predicts increased distress in ICD patients independent of shocks. Pacing Clinical Electrophysiology, 31, 20–27.

    Article  Google Scholar 

  • Pedersen, S., et al. (2009). Increased anxiety in partners of patients with a cardioverter-defibrillator: The role of indication for ICD therapy, shocks, and personality. Pacing Clinical Electrophysiology, 32(2), 184–192.

    Article  Google Scholar 

  • Pedersen, S., et al. (2010). Pre-implantation implantable cardioverter defibrillator concerns and Type D personality increase the risk of mortality in patients with an implantable cardioverter defibrillator. Europace, 12, 46–52.

    Google Scholar 

  • Pihl, E., et al. (2011). Patients’ experiences of physical limitations in daily life activities when suffering from chronic heart failure: A phenomenographic analysis. Scandinavian Journal of Caring Sciences, 25(1), 3–11.

    Article  Google Scholar 

  • Priori, S. G., et al. (2013). HRS/EHRA/APHRS expert consensus statement of the diagnosis and management of patients with inherited primary arrhythmia syndromes. http://www.escardio.org/static-file/Escardio/Press-media/press-realeases/2013/diagnosis-management-patients-inherited-primay-arrhythmia-syndromes.pdf. Accessed 8 Aug 2017.

  • Priori, S. G., et al. (2015). ESC guidelines for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death. The task force for the management of patients with ventricular arrhythmias and the prevention of sudden cardiac death of the European Society of Cardiology (ESC). European Heart Journal. https://doi.org/10.1093/eurheartj/ehv316.

  • Rosamund, W., et al. (2007). Heart disease and stroke statistics – 2007 update: A report from the American heart association statistics committee and stroke statistics subcommittee. Circulation, 115, e69–e171.

    Google Scholar 

  • Sager, M., & Zuiderent-Jerak, T. (2016). Standardization from the heart: Resisting evidence-biased medicine and complexity-biased STS. (unpublished article).

    Google Scholar 

  • Schroeder, M. O. (2016, January 28). Preventing sudden cardiac arrest in kids. US News, p. 3.

    Google Scholar 

  • Sherrid, M. V., & Daubert, J. P. (2008). Risks and challenges of implantable cardioverter defibrillators in young adults. Progressive Cardiovascular Disease, 51, 237–263.

    Article  Google Scholar 

  • Sowell, L., et al. (2007). Anxiety and marital adjustment in patients with implantable cardioverter defibrillators and their spouses. Journal of Cardiopulmonary Rehabilitation Preview, 27, 46–49.

    Article  Google Scholar 

  • Spindler, H., et al. (2009). Gender differences in anxiety and concerns about the cardioverter-defibrillator. Pacing Clinical Electrophysiology, 32, 614–621.

    Article  Google Scholar 

  • Sudden Cardiac Arrest Foundation. (2015). AHA releases 2015 heart and stroke statistics. SCA News. https://www.sca-aware.org/sca-news/aha-releases-2015-heart-and-stroke-statistics. Accessed 15 Apr 2018.

  • Swindle, J. P., et al. (2010). Implantable cardiac device procedures in older patients: Use and in-hospital outcomes. Archive of Internal Medicine, 170(7), 631–637.

    Article  Google Scholar 

  • Taborsky, M., & Kautzer, J. (2014). Summary of the 2013 ESC guidelines on cardiac pacing and cardiac synchronization therapy. Cor et Vasa, 56, e57–e74.

    Article  Google Scholar 

  • van den Broek, M. (2012). Specialist in ontregelde ritmes. STIN Journaal, 4, 23–25.

    Google Scholar 

  • van den Broek, K. C., et al. (2008). Shocks, personality, and anxiety in patients with an implantable defibrillator. Pacing Clinical Electrophysiology, 31, 850–857.

    Article  Google Scholar 

  • Van Riet, E. E., et al. (2014). Prevalence of unrecognized heart failure in older persons with shortness of breath and exertion. European Journal of Heart Failure, 16, 772–777.

    Article  Google Scholar 

  • Van Veldhuisen, D. J., et al. (2009). Implementation of device therapy (cardiac resynchronization therapy and implantable cardioverter defibrillator) for patients with heart failure in Europe: Changes from 2004 to 2008. European Journal of Heart Failure, 11(2), 1143–1151.

    Article  Google Scholar 

  • Versteeg, H., et al. (2011a). Post-traumatic stress in implantable cardioverter defibrillator patients: The role of pre-implantation distress and shocks. International Journal of Cardiology, 146, 438–439.

    Article  Google Scholar 

  • Versteeg, H., et al. (2011b). Type D personality and health status in cardiovascular disease populations: A meta-analysis of prospective studies. European Journal of Cardiovascular Prevention & Rehabilitation, 0, 1–8.

    Google Scholar 

  • Vlay, S. C., & Fricchione, M. D. (1985). Psychological aspects of surviving sudden cardiac death. Clinical Cardiology, 8, 237–243.

    Article  Google Scholar 

  • Von Bergen, N. H., et al. (2011). Multicenter study of the effectiveness of implantable cardioverter defibrillators in children and young adults with heart disease. Pediatric Cardiology, 32, 399–405.

    Article  Google Scholar 

  • Weber, M. A., et al. (2006). Who should be treated with implantable cardioverter-defibrillators? The American Journal of Geriatric Cardiology, 15(6), 336–337.

    Article  Google Scholar 

  • Wilde, A. A. M. (2007). Erfelijkheidsonderzoek en de gevolgen daarvan voor ICD-indicaties. ICD Journaal, 4, 4–5.

    Google Scholar 

  • Wilde, A. A. M., & Simmers, T. A. (2009). Primary prevention with ICDs: Are we on the right track? Netherlands Heart Journal, 17(3), 92.

    Article  Google Scholar 

  • Wilson, M. (2010). The relationship between religiosity and quality of life in patients with implantable cardioverter defibrillators. Doctoral dissertation, East Carolina University. http://hdl.handle.net/10342/3193. Accessed 3 Aug 2017.

  • Young, D., et al. (2013). Survival after implantable cardioverter-defibrillator implantation in the elderly. Circulation, 127, 2383–2392.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Science, Technology and Policy Studies, University of Twente, Enschede, The Netherlands

    Nelly Oudshoorn

Authors
  1. Nelly Oudshoorn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Nelly Oudshoorn .

Rights and permissions

Reprints and permissions

Copyright information

© 2020 The Author(s)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Oudshoorn, N. (2020). How Age Matters: The Emotional Work of Younger and Older People Living with Defibrillators. In: Resilient Cyborgs. Health, Technology and Society. Palgrave Macmillan, Singapore. https://doi.org/10.1007/978-981-15-2529-2_7

Download citation

  • DOI: https://doi.org/10.1007/978-981-15-2529-2_7

  • Published:

  • Publisher Name: Palgrave Macmillan, Singapore

  • Print ISBN: 978-981-15-2528-5

  • Online ISBN: 978-981-15-2529-2

  • eBook Packages: Social SciencesSocial Sciences (R0)

Publish with us

Policies and ethics

Search

Navigation