DNR

Hopefully it will never come to it, OP.

What happened with my father was that he was strong and active into old age, and then physically declined very fast over a few months. One day he just didn't wake up. His wife was naturally beside herself, called an ambulance, and they did attempt CPR. It didn't do him any harm because he was beyond help, but she was pretty traumatised by the sights and sounds. She moved home soon after and I think partly it was to escape those memories.

So there's that to take into account too.

I wasn't even aware that the terminology had changed and the amount of Oldies we are looking after is getting a bit out of hand at the moment...

I think much more needs to be made of the terminology change. It's now DNAR - Do not attempt resuscitation. Because the reality is that when people perform CPR they are only attempting to resuscitate a patient. It is brutal. Everyone has been saying it, but it's true. Everyone on a resuscitation team puts their all into regaining spontaneous circulation. But that's all that CPR can do. If there is a terminal process that lead to the arrest, all that will happen is the patient will arrest all over again.

I'm glad that CPR is a medical decision. I wish that people understood that better before they were faced with a highly emotional situation where they feel responsible for the survival of their relative.

My experience is similar to the PP. Dad had a number of infections in the 18 months before he died. The pretty standard pneumonia and UTIs of old age. Each one left him more frail until he could barely stand or see. He wasn't incontinent but it took him so long to get to the loo in his tiny bungalow that he frequently wet himself. He couldn't be left because he often fell trying to get out of his chair despite it being one of those ones that raised up to assist.

My Dad hasn't been resuscitated but has has a couple of episodes where he's ended up in hospital and had quite heavy duty interventions to prolong his life.

One of the first times he fell and then got covid in hospital. I was desperate for him to be kept alive. He had a lengthy stay in hospital and lost a lot physically and mentally and needed carers four times a day afterwards.

Faat forward a year to 2022. The last time he was admitted I tried to raise the issue of his quality of life and my mum shouted over me that he had a great quality of life.

He was struggling with mobility and communication before the last hospital admission but has now spent the last 2.5 years being doubly incontinent, can't move, can't see, we don't know how much he understands any more although sometimes will start crying. It's horrible to watch and contributed to other relationships within the family becoming strained or breaking down.

I think the key thing is that any intervention is unlikely to get your mum back to the state she's in now.

Also it's definitely worth speaking to your family and trying to come to a consensus and being open. My dad used to always tell us he didn't want to be kept alive in a home but somehow has ended up signing an incoherent end of life document that infers he does want to be kept alive but isn't clear. When the time comes it is helpful to have clarity.

@JudyJulie that's terrible. It was my main thought to do with the assisted dying debate tbh - first of all, let natural death occur without attempting to fight it in those who want that. Other stuff can follow once we have that.

I'm so sorry that your mother's wishes were not respected. This is certainly not what usually happens,

My MIL, (89 years,old, mid to late stage dementia) had a PoA and a RESPECT form which both set out that she did not wish to be admitted to hospital, to receive any treatment that would prolong her life or to be resuscitated. She then developed pneumonia.

The care home refused to offer any end of life care and insisted that she must go to hospital, although paramedics thought she would die on the journey. Once at hospital, the attorney present was ignored, she was resuscitated and she then lived a further ten days.

That was five years ago and I don't think I or her DC will ever get over it. Just be aware that even though you set up all the right things and try to protect your elderly person, it may all be ignored when it comes to the crunch.

This was going back to April this year and obviously I was asked unexpectedly when she was admitted to hospital with a broken hip. Prior to that she was living independently and carryout out housework and cooking meals. 100% mobile including getting up and down stairs, going outside to empty the bins, etc. Then the next day she's in hospital and I'm being asked about DNR. I thought she'd go back to the level she was at before, I didn't know she wouldn't. Nothing to do with rose tinted view, its to do with not knowing any different.

Sorry OP - wasn't trying to hijack your post.

It has probably already been said but I’m a nurse and a DNAR is a medical decision so doesn’t require agreement from family, however it is good practice to gain input from family.

I work with the elderly and if still for all escalation, it is absoloutely brutal on anyone at any age but even worse when people are becoming more frail. Broken ribs is really a given if there is any success and often they will still die from pneumonia caused by discomfort from the rib pain. Often deprivation of oxygen causes neurological deficit and I have worked on a cardiac unit where those who survived with downtime were 1:1 care needed, aggressive and fully dependent on all cares. Those patients didn’t even know where they were and definitely had little quality of life and I knew many families who said it would have been better for the patient if they had passed away with dignity from an arrest.

There is of course some reversible causes during an arrest and it’s not a one size fits all approach. We also get families concerned that putting in a respect form means we won’t treat anything and that isn’t the case at all. I do understand how difficult and unpleasant it is to think about as I agreed to DNACPR on my 57 year old mother in February after she suffered a catastrophic brain bleed, and despite being a registered healthcare professional, I did feel like I was signing her away despite them not needing my agreement, but she was able to pass away with dignity in comfort

I must apologise to you @username8348 if my comments were harsh, or if they upset you.

Ahh OP a very difficult and brave decision.

please be assured that your mum will still receive all the treatment that she should every step of her life ongoing.

I understand that some of the comments are harsh but the feeling in this particular subject is very strong. The experiences are very interesting and thought provoking.

Well done, it's a really awful thing to think about and discuss with siblings,

keep reminding yourself you have made this decision out of love, and should the need arise, would be letting your Mum go with dignity. It's what I keep telling myself anyway, hope that helps you and your siblings too.

I'm sorry you felt attacked and I apologise if I was one of the culprits but I do feel very strongly about this and can be overly blunt to make my point.

CPR resuscitation is absolutely brutal - and I'll be frank, has a poor likelihood of success, even if in hospital. And has fuck all to do with dignity - upper body exposed, lots of people surrounding them, family pushed to one side

I personally would not want CPR resuscitation or heavy duty chemotherapy. However I would want to have anti biotics for UTI & chest infections and palliative chemo / radiotherapy.

We discuss with relatives any time reviewing respect forms (forms that include escalation of care suitability for icu/dialysis etc). It's a medical decision at the end of the day but relatives are helpful to give insights into the individuals thoughts/wishes.

Dementia Itself is a terminal illness so resus status should always be considered. Cpr is brutal and in instances where the heart isn't the first thing to stop, unsuccessful in most instances. Those that do survive often end up in a far less functional state and more dependence than pre-arrest

I personally, and my family will be requesting dnars from 70s onwards. It doesn't stop any medical treatment usp until that point but allows for a peaceful and dignified death when the time comes

I think it's really good that you both agree. What you're going through is do difficult its much better in the long run that you both feel the same

I know, it's been very difficult reading tbh. I think you're doing amazingly. It's a lot to take in. It's really given me a lot to think about as well.

Mumsnet can be very cutting and I just think it's important on a thread like this for people to remember the subject at hand. Some of it feels unecessarily harsh.

The GP suggested DM sign a DNR but unfortunately she is vehemently refusing. She is 79 with AD. I actually think she doesn’t understand the likely consequences despite the GP and me trying to explain. The GP was quite brusque and I think my mum was thinking she just wanted to get rid of her, like she was giving up on all medical treatment. This is despite being a nurse and previously mentioning that there is no point being kept alive for the sake of it. I have left it for now as she was getting quite upset about it but I do think I need to talk to her about it again.

If mum is still socially active and independent then the doctor should have asked her what she wanted, especially as she was an ex nurse, it's not up to a family to decide, only to ask what they think mum would want and talk through the process, no one would know if you were dnr if you collapsed in the street so would call an ambulance anyway and cpr is not the same as a heart attack which can be treated.

The way the doctor asked you the question was appalling. Maybe feed back to the practice that the doctor could do with some help in discussing a topic as sensitive as this. And ask them about the ReSPECT process (worth looking at with your family even if it’s not used locally).

You’ve had a lot of information here about the process of CPR but we’d all happily undergo a brutal medical process if the outcome was worth it (childbirth for example!).

I think of it as “if your mother dies a natural death, would you want us to attempt to bring her back to life?” Bear in mind clinicians cannot offer treatment that would be futile, so it would only be started if they thought there was a chance of a good outcome (not just life, but good quality of life afterwards). Only a small proportion of cardiac arrests will respond to resuscitation.

It's very variable from person to person isn't it? My DSis is also a Nurse and has said she definitely wouldn't want a DNR for our DM.

DM was a Nurse and has always said "don't bother trying to resuscitate me" which I'm glad of as at least she's been clear and it doesn't leave us in the awful situation that the OP has.

I'm a nurse and I'd absolutely want a DNR for my mum.

Resuscitation (especially outside of a hospital) even for young/well people rarely works and even when it does can lead to life long problems.

I personally would want a natural death for myself and loved ones.

However I felt attacked by some of the posters which is obviously unpleasant under the circumstances

I can totally understand that this is such a difficult time for you but I don't think that anyone is criticising or attacking you at all. Maybe some of us have been a little frank with our responses. I'm sorry of any of my posts offended you. They certainly weren't intended that way.