Copd / elderly relative refusing hosp / needs oxygen, help!

[Tootsweetrodders]

Hi everyone.
Looking for a bit of practical advice regarding a close friend’s elderly mother who has COPD.

The family are having to call out paramedics increasingly often as elderly relative cannot catch breath and can no longer lay down in bed. They refuse to go to the GP and each time the medics try to advise a hospital admission. They need professional / medical assessment and to get access to regular oxygen.

Has anyone been through this with an older relative and can offer some practical advice? Is it possible to access oxygen at home via the GP? Are there any other things they can do to ease the COPD symptoms?

It does feel like perhaps they are close to the end now, especially without medical intervention.

Thanks for any advice / experiences.

Yes home oxygen is available but it would need to be accessed via GP or respiratory team at the hospital.
Would it be possible for your friend to contact the GP and outline their concerns for their DM's health and that they will not engage with health services. They may be able to do a home visit. DM would still have to consent to being visited but if the GP turned up, many people wouldn't turn them away. It's unclear when DM last had a review of symptoms and a Gp may be able to prescribe different inhalers to help. 999 is still advised if despite inhalers etc DM can't catch her breath as these patients are more prone to chest infections. So tricky but to try and get a GP home visit would be my first port of call.

A key aspect is respecting the patients wishes. If they don’t require interventions and appreciate this will have consequences with lifespan, then that’s up to them. No one is obliged to have treatment that will extend their life, or indeed even make them more comfortable.

Where it gets tricky, is the ramifications for others should a patient refuse treatment. They then can’t expect others to put up with an additional burden, BUT it’s up to people to make clear that’s the consequence AND stick to that. ‘Mum, I understand you have difficulty breathing but if you refuse acute treatment/hospital admission/routine management then there’s nothing I can do, so I’m going to bed as I need to get up early for work. No, I can’t stay up to help make you more comfortable, if you need assistance you will need to get that from the ambo’s and then in hospital, shall I call them now? You don’t want that. Okay, I’m going to bed. Goodnight.’ And do it.

Presumably she has decided not to prolong her life with oxygen at home. That is her choice.
I suspect she will die fairly soon anyway without that and so the dilemma will be resolved.

Does she have competence? If not the next of kin may be able to get her admitted. However it's possible she does want to live much longer and in which case she is entitled to no accept help.

To establish competence the patient is told information and then asked if they understand, if they're competent the answer will be yes or no, in non competence they will give a random answer. For instance (paramedic training, but a genuine situation) MiL was told the after head injury protocol and when asked if she understood she said boat?

My dad had COPD. He had an oxygen machine at home that he was permanently connected to 24hrs a day via several meters of tubing (long enough to get anywhere in the house and onto the patio in the back garden. He also had several oxygen tanks in case of a power outage, or if leaving the house (he never left the house for anything other than hospital admissions in the last 2 years of his life) and a nebuliser at home to help clear his lungs.

As COPD progresses they can get access to these tools if they want to engage with the support that is available.

But it is their decision if and how they wish to engage. Near the end my dad was getting worse and really should have been in hospital but he knew his time was limited and didn't want to go in and potentially spend his last days there. He died at home during a heat wave when breathing became too difficult to sustain, but it was the way he wanted it.

Let them know there are options available, then all anyone can do is support their decisions. Such a horrible disease and so distressing watching someone struggle to breath.

Most COPD patients don't lay flat so that's pretty normal.
Although she won't go in does she have the respiratory rapid response come out? they can ask for nebulisers of Sabutamol and saline, do sputom and blood tests and ask for antibiotics.
Does she have rescue packs at home? They don't seem to like giving O2 at home at the moment.
Having just had my sister in hospital for this yet again and seeing the care given I can understand her reluctance particularly if she's less mobile.

https://www.asthmaandlung.org.uk/symptoms-tests-treatments/symptoms/breathlessness/how-can-i-manage-my-breathlessness

Exercises can help, some evidence for using an air fan on their faces to help too.

Thank you so much everyone, really great help and tips, I will share on💛