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.

No, that’s not correct. It’s higher than that. About 24-40% of all people who have a cardiac arrest in hospital survive. About 10% of those who are not in hospital. It does worsen with age, but just under 4% of those in their 80s who have a cardiac arrest outside hospital survive.

And knowing my mother is out the country on holiday like he expected me to call up my mum and tell her the doctor reccomends you put DNR on his medical records

When my father died he was 88 with advanced heart failure. CPR would have been futile and he wouldn’t have wanted it. Nevertheless when I found him and called 999 I was told to attempt resuscitation and when the paramedics arrived I had to produce the physical document to prevent them doing it, even though he’d been unresponsive (dead actually) for at least 45 minutes by then. You need to have it in place, otherwise they’ll break his ribs and in the highly unlikely event they could restore circulation he’d probably be brain damaged.

Don't be so bloody ridiculous.

It's based on whether or not it would benefit the patient.

There is no one size fits all answer. It’s decided on an individual basis as every patient’s medical situation is different and it should be discussed with family (whoever has POA) before formally being put in place.

It should depend on every ones individual wishes.

Which hospital did this take place in?

You are deliberately misunderstanding what posters are saying.

I was at the bedside of an elderly relative today. DNR was discussed.

Dr said if the time came, they would make the call and almost always it's to not resuscitate.

Imagine a frail 85 year old receiving CPR? It will break their ribs, can starve them of oxygen, and they'll perhaps die shortly after. Its NOT worth it as they'd have zero quality of life.

In YOUR case, you were young, I assume no underlying issues? The drs made the call to resuscitate.

Educate yourself.

It’s great that I have a POA in place, so I’m going to be covered and not have to depend on stuff like this

You should look into this more closely.

Having POA for someone doesn't give you the right to make DNR decisions against the doctors

DNR only means don't do CPR or artificial ventilation in the the event if cardio respiratory arrest.
It's not related to quality of life rather to advanced years and co morbidities as as we age our bodies physiology deteriorates and we don't benefit from effectively buying time with a ventilator until the body heals itself from a temporary illness and get back to full health.

My mum has dementia.

She has also had pneumonia twice. The first time we'd signed a DNR.

She's already on the lowest level pureed food, doesn't know any of us, can't toilet herself and spends the majority of the day in bed.

The second time she took pneumonia we didn't even send her to hospital, they'd already told us they'd only keep her comfortable and we could do that ourselves. She pulled through that again.

But I am 100% on board with DNR and will make sure I have it in place.

Who really wants to be brought back from the dead when they've already no quality of life?

To be honest DNR is about letting someone who is elderly and nearing end stage of life die with dignity rather than the violence of trying to resuscitate a fragile body by pounding his heart and fracturing ribs etc. It means he passes peacefully and not that they will let him die if there is something that can be done medically for him. It takes time to put in place its not just a case of writing DNR on his file and it is at this end stage of life the right thing to do. We did it for Mum finally and struggled to get Dad to agree to it, although afterwards he expressed he was grateful we had pushed him hard to do it about 3 weeks before Mum went - it meant it was a peaceful passing and we could sit with her, hold her, sing/pray/story tell. Dads was less so - he had no DNR and died after 3 resuscitation attempts by ambulance and air ambulance staff including a Dr. It upsets me to think about it even 3 yrs down the line, I wasn't even there, I do think both my sisters who were had a level of ptsd from what happened.

Everyone will die, that's the one certainty - you can't bring frail elderly people with organ failure back from death.

DNR is entirely appropriate under the circumstances. Often the way it’s approached (particularly in hospitals) isn’t very sensitive to the patient or families. Sorry you were upset. It doesn’t mean it’s the wrong thing to do though.

When my dh had aDNR put in place, he was not compos mentis and he has no idea what was involved. We put in a complaint about this and it has been removed from his NHS record. Ppl need to be aware that this sort of stuff is being employed off stage left. But I’m leaving this convo as no one seems to want my feedback.

Sorry to hear you have had a difficult day. Do not resuscitate is often an emotive subject , with family members believing that it means drs are giving up on their relative. It truly isn’t about that. DNARs are discussed when it is believed to be in the best interests of the patient. Where resuscitation is highly unlikely to be successful and even if it was ( extremely slim chance), the result would be a complete loss of quality of life for the person who already has underlying co- morbidities . It doesn’t mean no active treatment will be given at all. Allowing a peaceful death is often the kindest thing we can do for our loved ones. Unfortunately, many elderly people with co morbidities do not have an advanced care plan or DNAR in place prior to hospital admission. This means that the discussion tends to happen at ‘crisis point’, with an unfamiliar dr when ideally, the discussion should take place prior to this, initiated by someone that the patient/ their next of kin know and trust ( such as their own gp). If I had an 85 year old relative with dementia, I would actively seek to have a DNAR and care plan in place in the community. It is something I will arrange for myself when I get older too.

My Nan didn’t have dementia or Alzheimer’s. She requested her own records to state DNR - it was hard as she was fairly mobile and still could enjoy a meal out and about. But she didn’t want that to be taken away from her and if something did happen to her she was didn’t want to be immobile in a care home.

After a fall she was taken into hospital, she reminded everyone she had DNR on her records. We all said she won’t be going home, she passed away quietly after 10 days, her care was not affected by the DNR the doctors and nurses still cared for her and treated her medical issues regardless with the same care & treatment as if she didn’t have a DNR in place.

Heartbreaking but it was her choice & at 84 years old her right.

Sorry that is been a hard day and it is scary hearing choices being made :(

Does he have capacity? If so then he should be included in decisions about his care.

Yes, he had capacity, but she overrides his decisions so that’s why I put in a complaint

Surely PP wasn't asking you, unless you are OP with a name change?

No, I’m not OP

I always like to think of dnars as "if the patient was to stop breathing or their heart was to stop, then we should let them go peacefully"

Ie. No heroics / cpr/ ventilators etc.

It does not mean stop all treatment.

It is a medical decision and is good practice and recommended to discuss with family but ultimately it is a medical decision based on the liklihood of it working. In a 85yo with dementia, I think it is entirely appropriate to have a dnr in place.

You’re just being obnoxious and making the post all about you. An 85 year old frail human being is very different to a healthy human being that has carried a pregnancy. Completely different medical outcomes.

You are showing yourself up with your ignorance.