To think the ressusitation of the over 80s gains very little

[ReallyTired]

I have had several elderly relatives who have had strokes and then been saved by the intervention of modern medicine. They have then suffered a couple years of sheer misery in a nursing home. Their life may have been prolonged, but quality is non existant. Certainly my poor gran keeps saying she wanted to die during the last 18 months of her life. I can't help thinking they would have been happier if they had been allowed to die naturally in the comfort of their own home.

I feel that if we are going to artifically prolong life then we should also have enthanisa for situaitons where prolonging life has been a mistake and caused nothing but misery.

I am not sure what the most ethical way of doing this is. Prehaps elderly people should be encouraged to have a living will to state if they want to be ressusitated or under what kind of circumstances they would want enthanisa.

Somehow we have to have a system to stop greedy relatives from wanting granma killed to save on the nursing home fees.

I agree with what FanjoForTheMammaries said, you can't just apply and age limit as people's health and fitness varies so much.

My granded got married again when he was 83, and at 86 was still volunteering and helping out "the old folks" as he called them. Most of them were younger than he was. He died age 93, but only really seemed like an old man from the age of 90.

I totally agree that if someone requests a DNR for themselves, it should be respected.

"Kewcumber, sometimes the person themselves are not in a position to decide for themselves though" - yes I did say that when someone is incapable of making the decision themselves it should be up to their next of kin.

"I think you have to take these things on a case by case basis"

You've answered your own question haven't you?

And wanting to die because you are miserable isn't same as having a DNR.

My grandfather died of cancer some years ago now and went through a very very difficult patch where his quality of life was low and he was very depressed. A boatload of Prozac later and he wasn't particularly him IYKWIM but he certainly lived another 2 months in very little pain and slightly spaced out in relative contentment.

My granddad was in and out of hospital from when he retired. He had a stroke in his mid 70s - in fact he had two, one right after the other. The doctors prepared us for the worst. They said it was very unlikely he would make any sort of recovery, and if he did recover full consciousness he would be severely brain damaged. Anyway, after being unconscious for about a month he did slowly regain consciousness, and was practically the same as he was before, apart from a bit of dementia, though not severe at all. He lived a pretty nice life and saw me grow up, get my degree, get a job, met my future husband and died at the age of 84.

My own parents are now approaching their mid seventies and are very fit and well. I would be horrified if someone thought they were too elderly to bother with. They have everything to live for AFAIC.

Your chances of recovery post arrest are not great unless you happen to be in a hospital bed, attached to a cardiac monitor in an area where staff can actually read the monitor e.g. on a cardiac ward. This is not a clear cut will we save this person or not decision.

Thing to remember about an arrest situation is that effectively the person has died already, the heart or breathing has stopped or become so ineffectual as to be unable to sustain life. This is not the same as a stroker being" very unwell"

I absolutely agree with the way it stands now in that it's the doctors decision. Ideally the patient should be asked for their thoughts/wishes or family if the patient cannot communicate but ultimately it's a drs decision. Resus is also avery traumatic and undignified way to die.

This thread is alarming in away in all the misconceptions there are about resus and what it means. People need to be clear about a DNR is nothing at all like or in any way like euthanasia.

Going back yo the op though, YABU as it is always a case by case decision and always based on the pts best interests.

Up until his 89th birthday last year my grandfather was fit, well and had a great quality of life. On his 89th birthday he was admitted to hospital with a urine infection. A week later whilst recovering on the ward he had a cardiac arrest. He was clinically dead and the crash team took 45 minutes to get his heart going again. The crash team were amazed and my grandfather was the talk of the hospital.

Fantastic. However, those 45 minutes without oxygen to the brain have left him immobile, incontinent, with significant cognitive impairment yet just enough lucidity to know that he is not the man he was. He is now in a nursing home, gets regular bouts of pneumonia, is very depressed and wants to die. I think that the crash team did a wonderful thing medically, but it was the wrong thing.

My MIL had a DNR in place when she was 65. She was in hospital with COPD, was too weak to survive ventilation and wanted to go. She came through that episode to have 4 years or so of a reasonable quality of life before dying of lung cancer last year. The last 2 weeks of her life were hellish and she wanted to go. As someone else said, you wouldn't put an animal through that.

My point is that preserving life at all costs is very noble, but in my experience can result in pain, horror, distress and indignity.

Please remember that resuscitation looks NOTHING like in ER / Caualty etc
it is brutal
a relative took months to recover from watching them trying to drag her husband back from death
for an hour
in vain

the stats for patients who have been resuscitated ever being well enough to leave hospital are SHOCKINGLY low. Last time I looked into it under 1%
ie 99 of 100 people put through that never leave hospital

sorry kew, only skimmed, and didn't see that.

It's such an emotive topic.

I disagree that 80 or any other random number should be an automatic cut off.

I think medical staff need to really consider what is genuinely in the best interest of each individual patient, coupled with the views and wishes of relatives. the policy which we experienced, to preserve life at all costs is not the best one.

OP - you seem to be mixing up issues or trying to move the debate away from just DNR. DNR is not the same as do not treat, pulling life support or euthanasia. They are all separate issues with a lot of concerns and debates mixed within them alongside how improved pain management, palliative care, and just general better care for people would change choices (alongside cresentmoon's comments about how outside pressure can change choices as well - our society puts a very big emphasis on not being a burden, not being dependent and we can't think this does not effect things).

Also, many people have valuable, enjoyable, happy lives even while in constant pain. My DH is one, has been for many years, will likely always be in pain and his wishes are always attempt resuscitation. He gives anyone an earful when they suggest otherwise (and he has sadly had people tell him otherwise).

I don't think you can use being over 80 as any sort of reliable indicator of whether someone should be resuscitated. I speak as someone whose mother and grandmother were exhaustingly active well into their 80s and it wasn't their age, but their respective medical conditions that basically determined how they died.

I have friends who lost their parents at much earlier ages and one friend, in particular, whose father was only in his 60s when he had a stroke that robbed him of all faculties. Because he was 62, he was resuscitated several times and spent the next three years, before he died, in hospital plugged into various machines that kept him, technically, alive. But being alive is not the same as having any quality of life and my friend's mother was determined that she didn't suffer the same fate. So she made sure she'd left very clear instructions about how she should be treated if she developed a terminal illness.

Ultimately, it has to be down to the patient but age is only one part of a very difficult equation.

MIL had been resuscitated several times in the last few months. Finally her organs shut down and DH was asked to sign a DNR. We knew she didn't have the fight left and the drugs they had given her meant she would probably not come out of hospital. He signed it. He doesn't even remember the whole night but we sat with her and watched her slip away. She was 64.

DNR is up to the individual but I agree with a PP who said that resuscitation can be brutal and very damaging, this needs to be considered by everyone involved.

My granny is 94, lives alone and is fitter than a flea. She still does my parents garden once a fortnight. It makes me sad to think due to her age people think she might not be worth resuccitating.

I want to be just like her when I grow up.

Agree that resuscitation is a drastic process with a lousy risk: reward ratio for the over 80s. My gran is nearing the end of her life, and has a DNR by general agreement of her family and HCPs (but without her consent as she has severe dementia).

She receives antibiotics, oxygen, Complan-type drinks to keep her strength up and anti-depressants. But if she had another heart attack nobody will be giving her electric shocks or bashing her chest and breaking her fragile ribs. She will not wake up in unfamiliar surroundings plugged into a machine. She will simply die, which is the right thing for her at the end of her very long life.

katiescarlett, that's lovely for your gran and just over a year ago my grandfather was the same. Bussing it all over brum, out and about every day, gardening etc.. but an 89 year old suffering a cardiac arrest is very different to say, Fabrice Muamba - a young fit man.

My mum was at the hospital when my grandfather had his arrest, and over a year on she is still traumatised by it. And she is suffering with the guilt that her dad is living a 'hell' that he really didn't want to.

Surely the point is that there cannot be a 'one size fits all policy'? My dad was absolutely determined to live, and had survived resuscitation 4 times before over his lifetime, so to have said to the doctors that they should DNR would have been betraying him. His death was terrible enough without carrying that with me.

For others, the betrayal would be to let them live on. There should never be a blanket policy, to suggest otherwise is a pretty scary road to start down.

My aunt is a proverbial creaking gate, she has been unwell for about 20 years. Five years ago she had a minor op in which she had a cardiac arrest and was resuscitated then had a stroke when recovering. She now has a poor quality of life and repeatedly asks why she has to go on, why did they bring her back, why doesn't God take me, etc.

Having said that, my mother is now older than when aunt had her stroke and is fit and healthy. She says that she feels people live too long nowadays and (at the moment) doesn't want to go on when she becomes frail.

There's no easy answer - if there were, it would have been implemented already!

My godmother was very happy until she was 97, though in her late 80s she had to get someone to move in with her, and in her mid 90s became pretty much blind and deaf as well as housebound, but could still manage large-print playing cards and Scrabble, so apart from telling me every time I saw her, "Don't grow old, dear", no-one would have any difficulty in agreeing she had quality of life.

But then things got worse aged 97 - the final straw being all her teeth falling out, and she went into a fantastic nursing home, but still a nursing home. Every time she woke up from then on she would ask anyone with her why they hadn't killed her. I couldn't answer that, so I'm ashamed to say I didn't visit much after that. Thankfully she slept most of the next two years until she finally died, but those two years were totally pointless. Thing is, there's no way anyone could have known that beforehand. Also, she still had all her marbles and controlled her own stashes of medicines - if she'd really wanted to die she could have arranged it. Who can tell what might have been better?

I just hope I can manage to die like my grandads - one said 'I'd rather die than go into a nursing home', repeated that when told in hospital there was now a space in the nursing home, rolled over and died. But more likely like my grandmothers who were totally absent from dementia long before they physically died. On the plus side this saved my grandma grieving when grandpa died, as she refused to believe she'd ever been married.

putting on my pocket philosopher's voice:

I think we look at this from the wrong way round. We live in a country with free healthcare. Our children are vaccinated and given milk every day to ensure their good health.

So, illness and disability is not as common in our society as it is in somewhere like the remote or developing parts of the world.

We are not used to seeing suffering. We are not used to dealing with our own pain, never mind a loved one's...which is a blessing, of course.

But, it does make our society a little naive about the ways in which the human body can fail - and the ways the human spirit can triumph.

That's why I'm against legislating for euthanasia.

At the same time, I do hope to find a friendly medic with a heavy prescribing hand when it comes to my parent's time...a wee, well timed, extra skoosh of morphine would be nice.

There's a difference between DNR a person with a catastrophic cardiac episode, treating the suffering of a dying person and thereby hastening the process, and actively ending a person's life because they are struggling wtih the way their life is.

I'm looking forward to being elderly. I am going to wear purple. A purple gimp suit, I think - just to see the look on my carer's face...

Huntingtons disease runs in my family, my grandad and great uncle had it. Both died not knowing who they were or who their family were. I didn't know my great uncle very well but he was a very intelligent man and went to Cambridge, my grandad was also extremely intelligent and a very good writer. He gradually began to forget who he was and became very aggressive and locked my grandma out of the house at 5 in the morning in her nightwear and also drove the car into the garage as he began to worsen, he ended up being sectioned and spent his ramaining years in a care home not knowing who he was or who we were, it was not him, he was i nappies and just sat there trying to organize the books on his shelf ( not knowing how to read anymore) and just getting very frustrated with himself and other people. I know that, had he had the choice he would not have wanted to live this way and would not have wanted to put us through this. My grandad was my hero and the most amazing, kind and intelligent gentleman you could ever meet, i began to grieve for him and think if him as being dead the minute i knew he was no longer himself even though i was just 12 at the time. If the option were available, he would have chosen to die before the disease took over. My mum has a 50 % chance of getting this disease, i know she wouldn't want me, my daughter and my younger siblings to go through what we had to witness with my grandad with her therefore i would be in favor of euthanasia for her if it came to that, we have spoken about it. I am 18 but already know that i would wish to be euthinised if i ever get the disease, i have a 25% chance and would not want my loved ones to witness what we had to with my grandad.

DNR means Do Not Resuscitate - ie. not to carry out CPR if a patient suffers Cardio-Respiratory Arrest or Respiratory Arrest. Basically not to take any action if their heart stops beating and/or they stop breathing (which inevitably means their heart will soon stop.)

If a patient is 'For Resus' then Doctors can still make the decision to stop CPR at any time during the arrest - they are constantly reassessing the patient's chances of survival & potential outcomes.
DNR is a decision taken by doctors if appropriate - & discussed with the patient if they are alert, - and/or next of kin.

Fluid Resuscitation is a different thing - eg if a patient is bleeding internally / externally then they need to have that blood replaced by more blood / fluids or they will suffer Cardiac Arrest. 'DNR' does not cover Fluid Resuscitation.

The decision to not 'actively' treat illness is a completely separate issue to Resus.
The decision to place a patient who is dying onto the LCP (Liverpool Care Pathway) is another separate issue.
Both those two decisions are not taken lightly.

The LCP is a care plan agreed by doctors to alleviate symptoms that arise when a patient is very obviously in the final stages of their life. For example the patient is offered food & fluid orally should they wish to have them, but not IV fluids as that constitutes 'active treatment'.
A patient can also be taken off the LCP should they actually show signs of improvement - very rare but happens. Then they will be 'actively treated' again.

Re: DNR - the majority of resus attempts in hospital are not successful - i've personally not seen a successful resus; but i know of a few that have been very successful; & the patients involved have walked out of hospital fit & well, including elderly patients.
I met one man in his 70s whose life was saved by his son at home, performing CPR. Sadly for his family this man had suffered brain damage through lack of oxygen & had short term memory loss.
I say 'sadly for his family' because the man himself was actually a very happy person & enjoyed life - he was otherwise physically fit, & a genuinely nice man to know.

DNR/For Resus, Active Treatment & LCP decisions have nothing to do with age, & everything to do with medical prognosis - this should IMO not change.

Euthanasia is another topic altogether - it's totally illegal in the U.K. anyway.

I don't think Living Wills are especially wise - honestly, no-one knows how they will feel if they develop dementia or have a stroke until it happens to them; so how can they make decisions in advance??

I will also say that my maternal grandad, & paternal Nan both had dementia. They both remained content with life & surrounded by loving family & friends until they died (of unrelated sudden illness). Their personalities changed, it's true, but they were generally happy.
People do not stop being human just because they get dementia. They are just different - they do NOT deserve all these people saying that they should have euthanasia. They too can have quality of life if they are well cared for & accepted just for being themselves.
I now suffer memory loss problems myself - it's actually not the worse thing ever, although yes, it can be incredibly frustrating at times.

My DMIL dropped dead leaving the bar on holiday.

After 10 years I still miss her, but I have to accept she'd have hated to have survived unable to look after herself.

One thing that strikes me having read this thread - is how many people die in their late 50s / 60s - it's so young!! Very sad.