When would you feel it’s the right time to enter a Do Not Resuscitate order for an elderly dementia patient?

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When would you feel it’s the right time to enter a Do Not Resuscitate order for an elderly dementia patient?

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I know of several sad stories where the efforts to save their lives ended in broken ribs or other injuries.

Alzheimer's & Dementia Care Decisions Health Care Directives

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This doesn’t exactly answer your question—in my previous job, I was required to take advanced life saving every three years. The last two times we did it, a paramedic from the city did the training, a city of about 350,000. One of my coworkers asked him in his years of experience how many times he’d seen CPR actually work. He said “honestly, never” He explained it, done correctly, was brutal, especially on the elderly, and really didn’t work. He cautioned us not to believe what we all see on tv, the miracle recoveries portrayed are the few, rare exceptions.
My dad always made it clear with each hospitalization, even though the documents were in place “don’t go pounding on my chest!” He rightfully feared it, far more than death. With a dementia patient, seems to me a DNR is a kindness

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Reply to Daughterof1930

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In 2013, I saved some guy who had collapsed on the street next to our patio where we were sitting. I remember running to him and going into rote mode with the training I’d most recently gotten in 2006. The model I used was 30 compressions to two rescue breaths. The guy came to when I had my finger in his mouth to clear his airway. He bit down, the paramedics came, and I had to go to the er too for a human bite wound.

It was still worth it.

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Personally, I agree with Lealonnie. I was lucky that both my parents did living wills in their mid-70s (I urged them to do it) with me as their DPOA and health care proxy. They both included strong DNR, no artificial nutrition, no intubation, etc. And when my dad was diagnosed with dementia a couple of years later, we knew it was all the more important to maintain his wishes. He said at one point a few months before his death, around the time he went into hospice “I lived a good life and am not afraid to die.” That comforts me a lot when I think back to decisions I made including nothing but oxygen and comfort meds when he developed aspiration pneumonia and died shortly thereafter. It’s what he wanted. And what I would want for myself if I were elderly with dementia.

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Reply to Suzy23

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Suzy, I was so cross when, after her GP had already stated that Mum should be on palliative care, that a locum GP called for an ambulance for Mum's chest infection. Thankfully, the hospital palliative care doctor was called to see Mum and he made sure she was given comfort drugs only. They ordered a hospital bed for her own home and the district nurse visits were arranged for when they discharged her.

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You put your question under the Alzheimer's/dementia category. If the person has dementia, the time is now for a DNR imo. I prayed daily for my mother to die so she'd be out of her misery with dementia, and she lived to 95+. I thought that was a cruel punishment, personally. Her signed DNR was useless, however, because advanced dementia and CHF killed her.

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Reply to lealonnie1

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My mom is 95.5 years old. Just moved her to memory care. She has a DNR but it's useless; she has asked so many times why can't someone help her die. It breaks my heart. I pray to God every night that he take her in his loving arms and give her the peace she's asking for. 😢

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It is up to the person him/herself to carry out an advance directive for themselves that is detailed in what wishes they have for their future. If they have not done this but DO have a POA or guardian, then that person can respond to any hospital admissions that the person doesn't wish resuscitation. This should all be discussed NOW with the person's doctor.

Generally when ambulances are called to a scene they legally MUST attempt reviving a person unless a POLST is hanging in their home (this is an MD paper done with patient/patient representative in the office, enumerating exactly what resuscitation measures may be done and may not be done).

My own personal decision now for my life is to not be resuscitated. What is YOURS and what measures have you taken to insure it is seen and acted on?

You are correct that in the elderly resuscitation is almost never successful, and as a retired RN I can assure you that your assessment that the ribs are often cracked is correct. I have heard them under my hands. Be comforted that the dead don't FEEL this discomfort, and few survive to worry about it later.

Decisions of this sort are plan-ahead. and in the hands of the person involved, or their agent (POA, guardian, next of kin.) and their doctor.

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Reply to AlvaDeer

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Never hurts to try.

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Actually, NOW is the right time. But it's not just the DNR that you have to consider. It's also what happens when a person with Alzheimers/ dementia can no longer safely eat or drink? The doctor will question the POA or caregiver about a feeding tube. My MIL lived an additional 2 or 3 years bedbound, non verbal & unresponsive due to receiving a feeding tube. Until cancer took her life.

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Reply to JanPeck123

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O.M.G. Speaking for myself, I cannot imagine much of anything worse than that at EOL. I have specifically included no ventilators, no feeding tubes, no tubes of any kind unless essential for comfort care in my advance directive. I also plan to look up the document AlvaDeer mentions that's published by Kaiser (they're our healthcare provider so I hope it's available on their portal).

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My Mom is 98 and has made that decision herself. She keeps reminding me that she wants to die. She says nobody should live to be as old as she is.

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Reply to jbramwell

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At 95.5 my mom says that too. We have the DNR, but I fear dementia or complications from that will be her demise.

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If you know of your loved one's wishes, those take priority over what you feel.

Elderly dementia patients, if resuscitated for any reason, invariably end up in the ICU, unconscious, with broken ribs. I have witnessed at least two cases in my own family.

I had opted for DNR for my wife who suffered from FTD for 18 years, based on her own wishes. We cared for her at home to the end. I wanted her to pass on in her own bed in her own home.

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Reply to Samad1

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I signed DNRs for both parents as DPOA.
My mother had a massive combo (both hemorrhagic and ischemic) stroke at age 89. From the Neuro ICU, she was transferred to a hospice house and died within 10 days as there was nothing more that could be done for her.
My father lived another 17 months in ALF. When he turned 96, I went to the head of nursing and signed a DNR. He had COPD, emphysema, and CHF. His lungs were shot and I witnessed him at an earlier hospitalization when the nurse asked him if he wanted to be resuscitated, he said "Hell no, I've lived long enough." When he started declining rapidly, hospice was brought in to keep him comfortable until he passed.
Thank goodness for morphine and hospice. I didn't want them to suffer. I have zero guilt for signing the DNRs. It was what they would have wanted.
I was sad that my mom didn't get to outlive my dad and have some peace away from his abuse. (64 years of marriage.) No tears for my father, though, only great relief that his reign of sociopathic narcissism was finally over. My long term PTSD has also improved since then. :-)

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Reply to NavyVet90

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Sending you hugs.

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My mom passed away a few months ago from cardiac arrest. The doctor resuscitated her once one. I wasn’t there and called me and asked me did I wanna have her resuscitated if it happened again I said no. She was 96 soon to be 97. She was growing weaker from various Falls and losing tons of weight and I was trying to help her in and out of hospitals rehab centers in the last year and a half nothing seem to be bettering her she just seem to be getting worse than her weakness, full transparency, I felt terrible telling the doctor that afternoon not to resuscitate her but in her condition and frailness I felt like it would harm her more than do her any good. I don’t think she would’ve come out of that situation better. She never wanted to live in a nursing facility and I just felt that is the direction she was headed in pretty rapidly. I miss her every single day and cry several times a day and always wonder if I made the right decision. The doctor actually said that I did so I found Solace in that because he said they probably would have broken ribs and it would just made everything that much worse, I don’t know if my mom would’ve wanted that as she didn’t have a living will but I don’t think she wanted to live in suffering. She saw my dad and grandmother on ventilators and said she didn’t want that but she never was clear on her wishes when I asked her directly. So that’s where you have to ask yourself what is the best option for your loved one and would they want to live suffering.
I hope that helps

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Reply to Carriebx

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So sorry for your loss. You should consider attending a grief support group. There will be others who will understand. GriefShare is just one example. They're usually sponsored by churches or other houses of worship, but you don't have to be a member of the sponsoring congregation, nor even religious. They might mention God or Jesus, but the topics aren't inherently religious. One my friends facilitates one of these groups. They might pray or ask people if there are things people would like to have prayer for, but no one is pressured to pray, Do a search online for GriefShare and enter your zip code. You'll receive a list of meetings near you, with the name, phone, and/or e-mail of a contact person. Take care.

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I agree, it is only a decision you can make. It was very difficult, but I signed DNR's on both of my parents when I placed them in memory care. My ex-husband had a stroke, and both him and honestly me regretted the life saving measures they made - he was never the same...some people are OK with that - they just want their loved ones...and you can coulda, woulda, shoulda all day long. For us, it was supremely difficult and for him - it was a horrible life. My parents are currently still "stable" and in mid-dementia stages, however, if something happens where they need a DNR...I feel it's time. <3 I wish you peace on your decision.

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Reply to sbuxmom72

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You need a DNR sorted before it's needed, so you should help your parents arrange that now, while they still have capacity to make some decisions. (I hope that they do.)

If that's not the case, speak with their doctor and find out what you can do in this regard. If you have POA, you should be able to arrange this.
But it needs to be done before it's needed.

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When would you feel it’s the right time to enter a Do Not Resuscitate order for an elderly dementia patient?

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