Doctor reccomending DNR

[B0yMama2]

I was in hospital all day with my 85 year old grandad after he had an unresponsive episode, my mother is next of kin and has power of eternity but she is out the country. My grandad has dementia but understands things going on arround him.
The doctor infornt of my grandad questioned why there's not a DNR on his medical notes and strongly advised me to tell my mum to put DNR on his medical notes. My mother said when he has no life meaning she will but at the moment he enjoys life, drinks, eats, walks with no issues and goes to the toilet with little assistance. When he can't feed himself, communicate or do anything for himself then that is when she said she will put a DNR in place. I'm just upset that he discussed to not save my grandads life infront of him, luckily I shut him down qwickly before my grandad caught on with the words it is my mother's choice.
I was also shocked at the amount of nurses I had to remind he has dementia and isant going to know when his birthday is or what his address is.

Did they explain what a DNR is? It's not that he will receive no medical treatment but that he won't receive CPR if his heart stops. This is rarely successful & can cause a lot of suffering so it's often not recommended in the elderly or frail as it can be so brutal.

Any medic will tell you that they would always insist on DNR for themselves or their family. Resuscitation is brutal, painful and doesn't work. Personally, I think ALL adults should automatically be DNR.

What a sad situation for you and your grandad OP. I’m so sorry.

Regarding the DNR, it sounds like you are more upset at the discussion in front of him rather than the decision to not resuscitate itself, would that be right?

Are you comfortable with what DNAR means for your grandad?

DNR is entirely appropriate for an 85 year old with dementia.

Many people with dementia do remember their date of birth and the nurses are not asking these things because they don't know he has dementia, it's all part of wider assessment.

It’s worth remembering that CPR is a medical treatment and shouldn’t be used in situations where it is very likely to be futile and where it will cause more harm than likely benefit. CPR is a traumatic treatment which can cause significant injury eg rib fractures and has a very, very low chance of success in patients who are very frail and where there is an underlying advanced disease process or ageing. It’s potentially life saving in some situations eg an otherwise healthy patient who has had a heart attack causing an abnormal heart rhythm that can be treated with a defibrillator but not if the underlying cause is irreversible.

They tried to get my dh to sign a DNR because it was convenient to them as he was in a care home for rehab. Totally unnecessary and they did not explain it to him. I did put in a formal complaint as he is fine, but it seems that the current system likes this shite. Everyone must object to this blanket DNR shite.

The chances of resuscitation being successful in an 85 year old with dementia is zero. Overall, 1% of people resuscitated in hospital survive to discharge and they are young and otherwise fit with a primary cardiac problem. When her time comes, let her die in peace, not sent out with a couple of broken ribs.

It's not mums decision, it's a medical decision based on if they feel he would benefit. He will still receive care. It was insensitive of the doctor to discuss it this way but its the right decision imo.

My dm was DNR. We were told that if they would resuscitate she wouldn’t have any quality of life. She was happy with this as had several medical issues that were making her life a misery. She’d had enough.

I am not sure you and your mother understand a DNR. It's to prevent extreme life saving efforts because the act of performing them is likely to cause more long term.

So your grandfather has a fall, needs medical care - absolutely. Suffers a stroke or major cardiac event - no.

My Dad is 85 doesn't have dementia, but has had a DNR for about 5 years. As others have said CPR is brutal and might be resuciated but with significant injuries.

I found the DNR for my dh totally inappropriate and it was not with his consent. It has since been deleted from his medical records as I did complain that it was totally inappropriate

CPR is brutal and rarely works. When it does people often have a significantly reduced quality of life. On the Ambulance programme on BBC one paramedic said in 10 years in the job she has only once done CPR on a person and they’ve left hospital alive, for this patient it was after a long stay.

A DNR doesn’t mean no treatment. My Mum had multiple tests for cancer, blood transfusions and an operations while having a DNR in place.

DNR is the kindest thing to do. Electric shocks and chest compressions are not pleasant and rarely have a positive outcome.

I had CPR in Labour with my last child. Should I have been left to die??

Were you 85?
I assume not- different impact on the body.

An elderly person's ribs are usually easily broken during cpr. If they survive imagine how much pain they would be in afterwards?

I’m guessing as you were in labour you weren’t 85 years old which means it’s significantly less likely to be successful.

@TangoinTokyo I think @Mum2jenny was referring to what @BeaRF75 said about all adults being DNR.

No but I take it you are considerably younger then 85 and don't have a life limiting illness.

CPR on people who are old almost always result in death or damage (bones are more fragile and take longer to heal) which will leave an elderly person with longer term problems.

So CPR is administered on an ageist basis? How is this not illegal?

I fully understand what DNR means, I was just upset that the doctor thought it would be appropriate to discuss it with me infront of my grandad knowing that I do not have any power of eternity and that he even started the conversation saying I know its your mother's choice

DNR doesn’t meant no medical treatment. It means we do not do extremely invasive treatments like chest compressions, electric shocks and a breathing tube down the throat to attach to a life support machine if someone has a cardiac arrest. These treatments are appropriate if we can treat the underlying problem; we cannot fix dementia.

If your grandad has a cardiac arrest and he receives CPR the most likely result is that he dies undergoing CPR. The only other possible outcome is that it works well enough to get him back to a much lower quality of life, with broken ribs, damage to his brain and kidneys from the period of CPR, and likely a pneumonia. All this on top of his underlying dementia which is unfixable.

The alternative is to accept an entirely medically, ethically and compassionately appropriate DNR and instead focus on treating things that are fixable (such as a UTI) and making your grandad’s life as happy and comfortable as possible for his remaining time. Then when your grandad does eventually pass, as he and all of us will, he does so peacefully.

Please consider accepting appropriate medical advice which is to not to do things that will only harm him, and instead only do things that might help him.

At what age is CPR not recommended on an age basis, and who sets the age limits??

It’s not ageist, unless ageing itself is ageist. It’s significantly less likely to lead to a positive outcome in people who are older and / or more frail