DNR

My nan who had no underlying health issues apart from old age and a tenancy for falls was given CRP while in hospital.

She was heavily brain damaged by the time she came back due to the loss of oxygen while her body was without oxygen.

Luckily she was able to spend the rest of her time heavily medicated and never had to consciously struggle with the brain damage.

I'm no expert but my takeaway was that resuscitation isn't straightforward as people get older and at my mother's request I have solemnly promised her I will instruct DNR (my mum is in excellent health but in her 70s and in no way wants to risk living with brain damage at the end of her life).

It sounds like your mum is doing really well atm OP. Can you discuss the issue with her? Often if you know her wishes it will make decisions so much easier for you and your siblings. As a side note, and presuming she still has capacity atm, have you / your siblings got POA for health and finance? If not please arrange this asap. It makes a huge difference to enabling any hospital discharges etc later down the road.

The problem is a lot of people think cpr works like it does on casualty on tv
they put the pads on shock them then they are jump started back to life and sat having a cup of tea 5 minutes later

the reality is on the older person they break numerous ribs and the possibility of further brain damage due to lack of oxygen to the brain whilst the heart stopped . It’s a brutal process that many don’t recover from and are left in a far worse condition

My dad had a terminal cancer diagnosis when he had a heart attack. I wish that my uncle had let my dad pass peacefully instead of calling paramedics who then pulled him out of his bed and did CPR and rushed him to hospital to formally die there. It would have been nicer to have been able to give him a cuddle and let him go gently. We knew he was going to die within 2-3years, we just didn’t know that it was going to be that day.

my dad had had a heart attack when I was a young child, 30 years before, and whilst he was saved by cpr then he had always said that he hoped he eventually died of a heart attack because it was not a bad way to go.

We agreed to a DNR, it's actually called ReSPECT now - recommended summary plan for emergency care and treatment and this is actually a much more robust document.

I will definitely look into this with your siblings. My father had dementia and his quality of life was declining rapidly. It was much kinder to let him go in that way then to put him through anything as traumatic as CPR when his quality of life was only going to decline further.

We also had this for my mother who had MND for obvious reasons .

If your mother is in very good health, it is unlikely that this would even take place until her health had declined so it is not unreasonable to delay your decision at this stage I would imagine.

I don’t think that anyone is disputing that CPR or attempted CPR has benefit to some. I’m living proof that it does, and at this point I have never been approached about the potential for DNR even though I am in advanced heart failure and have an assessment coming up with a view to going on to the transplant list. But I’m relatively young and still living a more or less normal life as far as it goes.

But the statistics for surviving a cardiac arrest are approximately 5% out of hospital, between 10/15% in hospital. So the reality is that resuscitation is more likely not to work, in which case, the person who is dying anyway and will soon have a very undignified death due to their dementia, will be physically shattered by an experience which they were unlikely to survive. And if they survive it they will potentially be left with complications, fractured/broken ribs, pneumonia, punctured lungs, something which in the mostly fit are things that are overcome in time, but in someone who is elderly and already declining does that really benefit anyone? Added to which there is a real possibility of brain damage after cardiac arrest, so CPR is likely to contribute to their decline.

There is a time to die, and we’re all going there.

Sometimes we need to allow nature to take its course.

In my case there are treatments to treat my heart failure. Subsequent to my cardiac arrest I had an ICD fitted and had other procedures to enhance my quality of life. I knew the transplant was in my future but I’m fortunate in that it’s taken five years to head down that road.

But there is no cure for dementia. The mother has 0 capacity from what OP has said. Who are they really keeping someone like that alive for? It certainly isn’t for the patient.

OP my mum has dementia but is physically robust. I've worked with people with late stage dementia. I hope she has a heart attack and dies before she gets to that stage.

A man I went to school with (in his 60s) was resuscitated a few years ago (out of hospital) and is fine and back working.

I agree that it isn't for the elderly, but it could just save someone's life if they are younger.

The benefits may not out weight the risks if this was carried out.
Plus there's a chance of physical injury and other life limiting issues x

OP I know a hospital doctor who says one of the worst things is when families haven’t discussed this beforehand and are in the corridor arguing or having highly emotional discussions when a patient becomes v sick. Do talk to your siblings. Wishing you well.

That was my Dads choice too

From what the OP says she doesn’t have capacity. How do you explain the pain to someone like that? The pneumonia, the broken ribs?

And moreover what dignity is the person afforded when their death involves someone having shattered their body first?

There’s such a thing as the right time to die, and IMO a cardiac arrest in these circumstances is that time.

If she is happy and enjoying life just now then trust your instincts and say no.

When the situation changes as dementia progresses, you can always agree to it then.

Edit to add we agreed to DNR for MIL as she is in now the later stages of dementia. She hardly eats, almost blind, deaf as a post, can't walk, totally incontinent, doesn't remember any of her family, forgotten she had a husband for 50 years and spends every day stuck in a loop wondering where her Mum is, and why her Mum abandoned her in the kids home. (She thinks the care home is a home for bad children).

Please don’t do this to your mum.

If she has a cardiac arrest there’s a low chance of successful resuscitation. If it is successful, the underlying terminal illness (dementia) still can’t be fixed, and she will have to deal with the complications of surviving cardiac arrest which can include rib fractures, pneumonia and further cognitive impairment.

I resuscitate people for a living. Where I work we do not offer CPR in these circumstances, as it would be unethical. We still offer lots of other treatment as appropriate. So antibiotics or IV fluids or things like that, but not something that cannot
improve someone’s life. If someone has a cardiac arrest in these circumstances we allow them to pass away peacefully.

I would not perform CPR or ask it to be performed on my mum in these circumstances, and indeed did not when this arose with my Dad. Accepting his peaceful passing was the last thing I did for him as his daughter.

OP I’ve had cpr and frankly I would not put an elderly dementia patient through it.

I had several fractured ribs and a bout of pneumonia to show for it, also, the brain can remain active for a part and I have actual memories of them starting the process.

If they’re asking about dnr they have reason to think resuscitation is not in her best interests.

If your mum is elderly and has dementia then she’s reaching the end of her life gradually. I’d want a DNACPR in this situation for myself or my mum.

I have done CPR many times on patients. It is brutal.

My mum is 78yrs and apart from arthritis is medically fit. I would not ask for resuscitation for her.

The actual act of CPR is just the beginning of the journey.. being ventilated in ITU, various invasive tests possibly being done, pain from broken ribs... maybe a chest drain if a rib punctured a lung... there is so much more to a person's recovery then just getting their heart restarted.

Far too much for an older person to recover from AND then have a decent quality of life afterwards.

Patient/family members do not actually have to sign a DNACPR form. It is a medical decision made by doctors but it is best practice to discuss with patients and their family before puting one in place.

For me it would be a no to CPR but I've signed a living will for no treatment if I'm diagnosed with certain conditions

Dementia doesn't improve. Say in 6 months she is in hospital for something and stops breathing, would you want to resuscitate for her then to go through the downhill slope of dementia? Or the lack of oxygen could affect her brain and mean she survives but the dementia is suddenly much much worse

However her health is quite robust and she's not suffering.

Dementia is a horrific illness, she may not be suffering now but she almost certainly will be in the future. It might sound quite brutal but a heart attack would have been a better outcome for my nanna than the last few years have been.

Sorry, I meant to say it is a shame you have not had those conversations when you could, but is there a possibility she might have done so with one of your siblings ?

Even if she hadn't, it is a big call for you to make, and it is good to talk about these things with other people who love her.

As per all the posts above.

We discuss things like this very openly in my family, and my dc know I wouldn't want to be resuscitated if this question ever arose.