CPR on very old sick people.

Some 90 year olds are more spritely and sociable than some 55 year olds. That's why age cannot determine it. The ONLY valid form is the official one. Cards, statements and tattoos are not and people with those but not the official ones will still be given CPR

When David was in hospital the last time, and it had been explained to us all that he wasn`t going to get better, the consultant said to us that he didn`t advise CPR if the occasion seemed to demand it. He said that not only do patients suffer broken ribs, they quite often suffer from brain damage as well, so we were all quite content to agree to DNR.

There was an excellent article in the Observer mag a couple of years ago, written by an American physician. He was in his mid 60's and had DNR on his notes. He said all his medical friends did the same. He described what happens when resuscitation takes place, painful and brutal.
Attempts were made to resuscitate my almost 90 year old relative, who was left black and blue. Thankfully the relative died of the heart attack, no doubt if the individual could have been asked - their answer would have been "leave me alone, I'm ready to go".
Im with you JessM and others who say there is a place for DNR

M0nica

This is exactly why my area has "Goals of Care".

It's a very common misconception among both patients and health professionals that "DNR" means "leave them in a bed to rot". NOTHING could be further from the truth. This is why blanket "DNR" orders are not recommended anymore - they do not address issues such as admission to ICU, surgery, admission to an acute care facility, IV insertion, treatment of acute illnesses (e.g. if a terminally ill person suddenly develops pneumonia, do we treat the pneumonia with antibiotics or do we provide comfort care only), etc.

But Monica the exact opposite has happened for my friend they almost forced intervention on her which she didn’t want

think I'll go for DNR now , to be honest.

I have no intention of having DNR written on me or my notes. i am leaving it to my children.

Having opted before the event for DNR if ill is virtually an invitation for medical staff not to bother to see if you are likely to survive any treatment.

Remember what has been happening at Gosport Hospital, and is still unresolved.

When I was a student nurse back in the 60's, anyone over 75 was automatically DNR unless their doctor had requested them to be resuscitated. Which I thought was a fair thing. These days it seems to be " resuscitate everyone unless they have a DNR order, even if they are 99".

I think that the change has occurred because of litigation - doctors are afraid to withhold treatment in case they get sued, so everyone is for full treatment unless they / their family request otherwise.

This is one case where I'd like to go back to the old days.

I have the paperwork to complete for a DNR - advance directive is, I think, what they call it - but keep putting it off. I must get around to it.
The OP wasn't proposing an age limit. As I understand it, she was referring to a patient "very old and in very poor health (who) dies of natural causes. Surely we can all agree that it would be inhumane to bring such a person back from what should be a peaceful demise. It's not what I would want for myself.

I could have written that myself JessM.
It is a brutal procedure, a sort of assault on the upper body, the ribs etc. Would you knowing,y inflict that on a frail elderly person?
DH knew the score when he signed his DNR some months before he died. Although only 69, there was no way his poor body could have withstood it and to what end?
It is not anything like what is shown on TV and we need to be clear in expressing our wishes. In our case, the hospital was very clear that we as a family should have the opportunity to discuss it so that our DDs were happy to respect his wishes .
Thereafter he wore a purple wristband while in hospital .
Nobody wants a loved one to die, but even less to suffer.

Make sure a DNR is in place when you and your partner/family think it’s the right time. It’s ok if you don’t want it but it was a comfort to us when we knew the inevitable was near. ?

In my area we have something called "Goals of Care". People can choose from three levels of resuscitative care (everything, everything except chest compressions, or meds only - no chest compressions and no intubation), two levels of medical care (admit to hospital and treat active medical conditions but no resuscitation and no ICU admit; M1 allows for surgery while M2 allows surgery only as a comfort measure), and two levels of comfort care (treat symptoms only; C1 still allows for palliative surgery but C2 does not as C2 is most appropriate for patients who are actively dying). This takes into account the fact that a straight DNR is really very simplistic and doesn't include consideration of other treatments. Patients go over the Goals of Care with their provider during each admission and are given a copy to take home. They're told to put it on their fridge so that if they need to call EMS the staff can quickly and easily find the document.

Although strictly speaking age shouldn't be a determining factor, you do have to remember that in a very old person CPR isn't likely to be effective. (CPR works in people over 65 less than 1% of the time). Remember that it's not very common for someone to experience a sudden spontaneous arrest. They do happen, but usually the person already has pre-existing health issues and the arrest wasn't unexpected. In most cases the heart stopping is the last in a sequence of events in which the body progressively shuts down. By the time the heart stops there's no one left to save because the rest of the body is already gone.

Bags my friend had a Do not resuscitate on her notes but when she was taken into hospital very ill ( but not in need of resuscitation) the dr insisted on an operation ( although she kept saying I m ‘do not resus’ ) to save her life and she has now endured 6 months of being alive but dying bit by bit month by month
She says it would have been so much better for her to have gone 6 months ago she now has to endure a slow death month by month she is very slowly bleeding to death very very thin and with no energy to do anything It’s a cruel end to a very vibrant funny kind lady

My dad was not fit but he was still fighting. He wanted every day even though to us he seemed to be suffering. I have no answers only the question of how to deal with the despair when the issue arises.

I think Baggs has the ideal solution. We can carry a card for blood donor or organ donation do a DNR card is sensible.

It's not necessarily an age thing Anniebach. Each case should be taken on an individual basis. There can be a seriously ill person in their 60s with no hope of anything but more pain and a fighting fit 96 year old.

I am against a cutting off age for medical assistance

My poor Dad did have a very clear DNR but they still resuscitated him. He was furious and died later that day. An overzealous young doctor afraid to get it wrong sadly. But she did!

It's very difficult to judge in advance the circumstances where you would or wouldn't want to be resuscitated. DH and I have discussed this often and I think we are aware of each other's feelings. How one would react in the heat of the moment I don't know.

I am inclined to agree JessM. I remember when a young relative was a student nurse she told me that she had just helped a very old, sick patient to be a bit more comfortable in her hospital bed; when she came a few minutes later the old lady had died peacefully. She was horrified to see the resuscitation team rush in, perform CPR and other procedures - they did manage to resuscitate her but she then spent another 11 days or so in misery before finally dying.

However, I will agree that deciding someone's life is not worth saving after a certain age is wrong - it depends on how ill or frail the patient is, what their quality of life is - and if they want to go peacefully or not.

DNR statements are a good idea - but when is the right time? Could we change our minds at that crucial point?

Yes I think we should carry a card to say do not resuscitate.
But no doubt that is fraught with problems, perhaps a tattoo would be better ( only joking).
An elderly relative has a signed declaration at the Drs surgery to state her wishes regarding not wishing to be resuscitated
Perhaps it’s time to carry mandatory instructions as to our wishes.

What about the old lady who was 111 last week? Was she not worth saving 22 years ago? I think it is a harsh decision to look at someone's age and decide not to resuscitate, bit like euthanasia. Should we all wear a label saying whether we want to live or not?

Totally agree JessM. Whilst I could never support euthanasia I think more ‘non-intervention’ is needed.

I think more of us need to make DNR statements and make sure all carers know to let us die naturally.

How do you decide if an 89 year old is in poor health in the time it takes to choose to do CPR? I know a 99 year old who had a heart bypass operation. Is there an age when we should simply be left to die?