Coronavirus - are older people being treated as expendable?

Thanks for sharing Lavazza1st Just hope none of us or our loved ones have to make a choice!

TBH a ventilator is not the be all and end all. I've heard it's extremely hard to be extubated after being on one and the odds of surviving one are not great.

In America, a nurse was crying on social media because they had run out of sedating and pain killing drugs - people on ventilators need to be sedated to keep them comfortable and also to stop them trying to breath on their own because it can damage their lungs.

All of my family have had a conversation and even the younger ones do not rate their chances on a ventilator. If there is a way we can make our wishes known I think we will choose a CPAP only and not consent to be put on a ventilator.

Eglantine & Maddyone Thank you very much and well done with your daily yoga E

Thanks for explanation Sally I said before we grannies wouldn't think twice about putting our AC & GC first before us. Answering your question the 72yr old may need more help than the 27yr old, so the 72yr old, knowing the 27yr was still being treated in intensive care. What is your answer to this situation Sally ? as I take it you are a nurse or doctor.

Turning things on it's head...... who do you think SHOULD be given the intervention of intensive v e care and ventilation, a fit and normally healthy for their age 27 year old or a normally fit and healthy for their age 72 year old?

I think that there is a great deal of misunderstanding surrounding this subject. My understanding is that as has been the case for many years, if a choice HAS to be made (and then only after all other options have been exhausted), outcomes will always be considered.

So if there is only 1 ventilator / extra care bed is available, and 2 people need it, outcomes will be considered. Ventilation, which is an invasive treatment, will often itself be a high risk procedure. So doctors will consider, 'if we ventilator this individual will they be able to breath for themselves when we remove it'? 'Which patient is most likely to survive ventilation and lead an independent lifestyle'? Or even 'do we have any other patients who are not coping well with ventilation treatment, for whom removal of their ventilation is the best opportunity for them to maintain life going forward'.

These are really difficult questions but not new, & not age based (though by very nature of their age, older people are less likely to respond to the degree of invasiveness). My grandson died after my son was advised to agree for h is ventilation to be removed in the hope that he would try to breath alone). My mother had her ventilation continued for several months, because she continued to fight. My son would in all probability not be offered ventilation due to his ongoing health problems, and likely premature death.

I don't like these decisions, but in all reality they have and will continue to be made, for the greater good.

Hi Yogagirl like Eglantine, I’m glad to see you posting. Hope you’re okay.

Nice to see you posting occasionally Yogagirl?

Doing my yoga every morning!

Had same sort of thing with my dear mum Eglantine21
Not being given a ventilator because your over a certain age would mean a terrible & frightening death!!

Starbird that never was, nor is current NHS policy. The statement came from some senior medic in the regions and was immediately repudiated.

Sorry I can't remember the programme, I have R4/World Service on nearly all the time, it could have been on either one. but it was a spokesman of some sort. He said specifically over 75 from care homes because the hospitals are not offering ventilators to older people at the cost of younger lives. If it is a matter of palliative care, it can be done just as easily at the care/ nursing home and save the pressure on hospital beds and staff. It is not a slur on nurses, it takes difficult decisions away from front line staff.

Everybody sees the choice as being between the young and fit with their lives before them and on older person and all are prepared to immolate themselves like Indian widows used to, throwing themselves on their husband's cremation pyres.

That is the easy choice, but in fact the young and fit will automatically get the ventilators. The struggle for the last available few will between 2,3, 4 elderly people all with different problems. If the choice is between you and the nasty old man or woman down the road, how would you feel then?

Let's face it folks, if like me, you're over 70, and as it will, it comes to a choice of who gets the scarce equipment/treatment, you or a younger person with the prospect of a better outcome, its a no-brainer, isn't it? So let's not kid ourselves...

Ventilators are not the only equipment used to assist breathing. They are the last resort, after everything else has failed.

The first step is a CPAP (Continous Positive Air Pressure) machine, which is a much simpler device, much easier to manfacture and get into use. These are the machines that people with sleep apnea use, my DH has one, It has just a standard nasal fitting to a machine that pumps air into the lungs. It dos not require sedation or complex monitoring.

I think that the majority of people admitted to hospital never reach the point of needing ventilation, only intensive nursing or are put on a CPAP machine and that is sufficient

Our local general hospital recently sent an appeal to all CPAP users in our area asking whether anyone had more than one machine, in which case culd they return any surplus ones to the hospital for refurbishment and re-use.

There were only 8000 ventilators in the NHS up until recently and they were 80% occupied. They are on order and will start to come in but very slowly. Yes ICU beds are being rationed to those with best chance of survival and that is inevitable. There is an NHS tick list for frailty and if you score 7 and above , you will not be picked up by ambulance and will not be taken to ICU. Older residents are being left to die in care homes rather than alone in hospital isolation. Drugs are in short supply for care homes as they are being diverted to NHS hospitals. So yes older people with health issues are seen as less of a priority but it has always been like this.

Yes ventilation is different than DNR but my daughter had to ask her patients this difficult question because of Coronavirus. She has indicated to us that as we are both 67 if things get really tough, that it is possible that should we become ill with this virus, that we may not be allocated a ventilator. I saw in the news last week that medics are considering the life chances of Coronavirus patients and if they’re less likely to recover they may well not get ventilation. Under normal circumstances these patients would be given ventilation but with a ventilator shortage? I would think, and it’s only my opinion, that these difficult decisions are already being made. I imagine that many patients are already just receiving palliative care.

I’ve googled Radio 4 but can’t find any reference to this.

Resuscitation is different to ventilation though isn’t it?

I wish that, many years ago, someone had asked us if we wanted DNR on my mothers notes. As it was she died and was brought back to more days of torture.

When they asked my husband if he wanted DNR on his notes we both said Yes. in unison.

I don’t see the point of resuscitation for a few more days or as happened with my sister ventilation to keep her “alive” when she was dying naturally.

I can only know for certain about the hospitals my family are working in.

It may happen if people ignore advice and numbers needing ventilators escalate. Then decisions will have to be made.

Just as a similar decision is already made in the treatment head injury or cancer. When there is no point in going on.

Do you have a link to the Radio 4 broadcast?

My daughter had to spend part of one day at the surgery ringing her older/oldest patients and ask if they would like a DNR on their notes. What a truly horrendous job for her to do. She asked if her Nana has one. I’m not sure, but I’m glad my GP didn’t ring me about that. I wouldn’t agree to it myself, I want to see my grandchildren grow up a bit more, the oldest is only seven.

It was on Radio 4 yesterday I believe about the over 75, plus encouraging people to sign DNR forms. Spain are are not given ventilators to the over 65s, there's not enough to go around. Terrible situation for medical staff to face.

It’s not entirely false news. My daughter and her husband are doctors, and they were told right at the beginning of this that there are insufficient ventilators and hard choices will need to made as the pandemic ramps up. That is why she told us in no uncertain terms to stay in totally. She has said that people over a certain age may well only get palliative care. The country does seem to be coping at the moment, but do we really know that the sickest or oldest patients are getting ventilators?

want

Star bird, where did you hear that? I have family working in different hospitals and age does not come into it when it comes to admissions.
Hospitals are admitting on the basis of need. If someone needs hospital treatment they are admitted.

If what they need is nursing at a lower level of infection then it makes sense for them, like everyone else, to be looked after in their home.

At present there is capacity in the system for everyone who need hospital treatment to receive it.

I really wasn’t to know who is spreading this fake news.

You brave girl Starbird
I'm sure we would all put our children & grandchildren before ourselves though.

Heard on radio today that hospitals are not accepting anyone over 75 from a nursing home. But nursing homes closed to visitors 2-3 weeks ago, so the inhabitants can now only catch it from staff.
It seems to me the real problem is lack of proper barrier clothing and knowledge/ adherence to the proper procedures.

Doctors are having to choose who to save due to lack of equipment, yet some firms claim they offered it to the government and were turned down.

Whether it is because we have new ministers and/or have sacked civil service heads I don't know but there seems to be total incompetence to deal with a situation that has been anticipated for decades and we must have seen coming as soon as it reached Europe. The response and resulting mess are a preventable and heavy burden on those who made the wrong decisions.

That said, I am 73 and would not wish to take the opportunity of life away from a younger person, so I will take all reasonable precautions and if I become ill will fight it alone at home.