Fawnby Asked September 25, 2024
When would you feel it’s the right time to enter a Do Not Resuscitate order for an elderly dementia patient?
Follow
Share
I know of several sad stories where the efforts to save their lives ended in broken ribs or other injuries.
33 Answers
Popular Questions
Related Questions
- if you have legal papers as durable power of attorney that your parents appointed you, can a sibling be the parent's health care proxy?
- What to do if parent's current stated wishes (with dementia) do not match their previous health care directives? I'd appreciate thoughts.
- What authority does an invoked health care proxy have?
- Stepmother will not give financial documents for my father. He was denied Medicaid, as POA what can be done without court involved?
Ask a Question
I broached the subject with him when I visited yesterday. He was clearly uncomfortable. I said that he didn't need to make any decisions right now, but I wanted him to consider it while he was in a position to.
I said that I thought a good option was to have it in place just in case he no longer has capacity in the future. I said that if he wants everything done to save his life now, knowing that he'll be able to deal with the outcomes of CPR, then he should state that. But to consider that if he does suffer some kind of cognitive decline, whether he'd be able to cope with pain and struggling to breathe if he doesn't understand why.
He felt better when I went through the options and explained that getting a DNR ready now, while he's in a position to do so, doesn't mean that his life wouldn't be saved by CPR, if necessary. He has a heart condition, so this is a real worry for him.
He felt that if he was no longer himself, that having CPR might not be a good option. He saw that the patients with dementia, who were in the same ward as Mum during her several hospital admissions, couldn't cope with pain and their confusion made it more difficult to care for them. He doesn't want to be in that position.
Then you add the fact that the brain may have not had oxygen for a while and brain damage may have occurred. Not in itself a big deal but if you are already talking about a person that has dementia as Fawnby has in her question this makes it much more difficult for the patient and caregivers. And there is probably no return to "baseline" if there is a recovery.
So...swmckeown76 make sure that your wishes are known. If a POLST is available (might go by other names in the State where you live) fill it out and indicate in each section what measures you want taken and there is a section in each if you want the treatment to continue or if it is for a period of time in case there is a recovery. But also please consider the worst case scenario what if you do not fully recover and are on a vent and tubes for the next 1, 3, 5 or more years do you want the end of your life to look like that?
My sister is fully aware of my wishes as well.
It has always been my stance that CPR works great on TV, works great on reasonably young healthy people...not so much on older, weaker individuals with other medical conditions.
In general CPR will break ribs.
It may crack the sternum.
Ribs that are broken may puncture the lung.
Now that you have brought a broken body back from the brink of death how much brain damage has been done due to lack of circulation to the brain.
And can this already weakened body recover from broken bones, maybe a collapsed lung and now maybe more brain damage.
So my stance is no CPR on an elderly person with dementia or other life limiting conditions.
The best thing is to discuss this and the possible outcome with loved ones before it becomes an issue. And if nothing else make your wishes known.
A bit of advice though.
If you do complete a DNR or POLST Make several copies.
1. For your refrigerator.
2. Keep one in your car
3. Keep one in your purse or wallet
4. Make sure that your doctor is fully aware and that they have a copy in your medical record. (the doctor should be aware since a doctor has to sign the form.)
And it is a good idea to have each of these copies printed on bright colored paper so it stands out.
If you call 911 and the DNR or POLST is not available "it does not exist" until it is presented. And if the paramedics are called they will begin CPR if the form is not available.
There are many disconnects that occur, example: the majority of EMT's after a 911 call will not honor a DNR while patient is in the ambulance. Their job is to get the patient alive to the hospital. The ER team may not have access to the DNR directive in a chaotic situation - they see their job as saving lives, period. The medical team involves a myriad of revolving staff- lots fall through the cracks with consistent attention to DNR's. Surgeons will not honor DNR's - their job is to keep patients alive during the surgery or their stats will go down. DNR's might be honored in recovery rooms after surgery, but it's a toss up.
So don't assume that DNR's will prevent the use of ventilators, feeding tubes, CPR, on a patient with clearly stated and legal DNR directives.
I plan to have DNR prominently tattooed on my chest. Not sure if even that would help.
Many of us pray to pass in our sleep so that these types of decisions don't have to be made.
My brother had a hard time accepting our mum's decision to have a DNR in place. I thought that he would feel the same as me and Mum, so I wasn't prepared for how upset he was.
He would never make that decision himself, whereas I definitely will. He wouldn't want a plug pulled either, whereas I would rather not be hooked up to a machine in the first place.
I honestly can't understand anyone clinging onto life, when there's no quality to be had. And, I'd imagine, that someone who hates the thought of dying can't understand how it really doesn't scare me, and others like me.
But they're still alive. With time and the best medical care (which I assure you, I can afford), they may still improve. It's precisely what I'd want. No one can ever treat you as a throwaway unless you let them.
Send your loved one to the Emergency Room with the POLST form.
I had to persuade my dad to agree to a DNR, in order for the medical repatriation company to bring him back to the UK when he became paralysed in Thailand. If he hadn't agreed and he had a heart attack mid flight, the plane would have to be diverted and land at one of the countries on its flight path. By the time he arrived at a hospital and was resuscitated, if successful, he would have suffered significant brain damage. The airline would not have agreed to him being taken on their plane without it, as he had a pulmonary embolism.
I am now 56 and already want to speak with my doctor about a DNR. However, after talking with my daughter, I will wait until my 60s. Nevertheless, I will ensure that it's done.
"Do NOT Resuscitate; Let me go to Jesus."
If a person has chronic debilitating health conditions and does not wish for "heroic measures", a DNR is a good idea. As an RN, I have been in many codes and also at bedsides of those who wished to pass without a code. I can't say which is better. It really depends on the person and their loved ones. If everybody is at peace with a natural passing, then a DNR can lead to a lovely passage from life.
Unless he was specifically referring to the elderly, I would be concerned. If it "never worked" then why is the public encouraged to be trained to use it and a priority for the Red Cross.
@PeggySue2020 responded "I saved some guy who had collapsed"
While this shows it can work, the question for this group should be how often does it work for the elderly, frail, or disabled? Also, I would be concerned how much damage might be done no matter how light the compressions. In an emergency, most people forget how much strength they are using.
As a routine question in the ER, I was asked if I wanted my husband to have CPR if needed. My initial reaction was "why not" so I said definitely. I discussed it with our cardiologist and his response was much like many here. Because my husband is not in the best of health and already dealing with so many health issues, would I want to risk the broken ribs to save his life only to add another major lingering issue to recover from along with whatever caused him to need CPR. So we put a DNR in place at our next visit to our geriatrician.
You need to be careful though the DNR is not misinterpreted. I have found even some health professionals think it means you want nothing done... including O2 and tests. A DNR should only come into play if/when the heart stops beating and/or lungs stop breathing. Until then, advocate for whatever you consider the best care to be given.
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. :-)
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.
For myself, I chose to not prolong life on my Health Directive at age 68 last year. I have osteoporosis and do not want to suffer.
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.
I hope that helps
It’s obviously your life to live as you want, but I wanted to correct your “fantasy” that a couple of broken ribs in a senior isn’t a big deal. It’s a big, giant freaking big deal.
The women who lived off coffee, cigarettes and amphetamines back in the day have severe osteoporosis now. (Generally speaking)
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
It was still worth it.