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.

Surviving does not mean quality of life. Most of those people, particularly the elderly will then have multiple issues, be bedridden, incontinent, tube fed etc etc etc. And die within a few days or weeks anyway. That's the reality. It is life prolonging, not life saving.

I think survival to discharge rate is lower than 4% in over 80s isn’t it? It’s closer to 2.5% isn’t it.

I do think it’s a conversation worth having with your mum OP. Assuming he survives the CPR at his age (and he almost certainly won’t) his life afterwards is quite likely to be very different to his life before.

Obviously it does depend on age and medical condition, but no way would I approve of a DNR on a OPA. But that’s my choice.

Both my parents (89 and 93) have DNRs in place. My mum's a retired nurse and told me she's seen horribly unnecessary outcomes for very elderly people who don't live for much longer anyway. Broken ribs, feeding tubes, brain damage, total incapacitation. She says when you are lucky enough to get to a great age, you'd rather go quickly when the time comes.

POA obvious

JFC @Mum2jenny have a bit of self-awareness. This thread isn't about you but the situation of the OP.

Absolutely. Everyone should have a detailed living will as to their wishes with regards to health intervention at end of life. It's a conversation you should have with all your family, before you get critical or without capacity, and is also part of the admissions process for care homes.

Exactly, you have summed it up totally!

I have a living will that specifically has a DNR in it for certain conditions and I'm 40!

My mum had one. Why resuscitate someone with dementia, to maybe then have painful broken ribs, brain damage, and months in hospital to then die again?

If I have dementia I don't want to be resuscitated

But that’s your choice, and I agree it’s up to everyone to state their choice.

POA doesn't always cover health decisions. You need to do that separately.

As to your earlier confusion on ageism, yes, of course medical treatment decisions are based upon age as it is central to survivability, and quality of life. Do no harm.

This.

@B0yMama2 in the nicest possible way discussing it in front of your grandad was the right thing to do. And it isn’t something that a family can ask for or ask not to get if the person doesn’t have capacity, it’s entirely down to the medical team.

DNR just means no chest compressions and putting a tube in to make him breathe and no defibrillator shocks. At that age chest compressions just break ribs. It doesn’t mean withdrawal of fluids or medication or any other care, just not restarting his heart once it stops.

I have an elderly relative in a care home who is in her 90s.
Surely to god if she passed suddenly they wouldn't try and resuscitate her? The thought is filling me with horror.

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

That. I was with my mum when the doctor at the hospital asked her if she wanted heroic measures taken should her heart stop. He explained exactly what effect it would have on her frail body, And that if she survived it she would be in great pain from multiple rib fractures and with possible brain damage.

Seriously, who would want that? I had a cracked rib once, and every breath I took was so painful. Multiple fractures? In an already sick 88 year old? That's not what I'd want for my parent.

When I was a medical student I saw CPR being performed on a very elderly gentleman. Remarkably it was successful in restoring a pulse. He briefly regained consciousness and grimaced and groaned, reached with his arm, he looked terrified. Then a few minutes later he arrested again, and died. It was one of the most hideous things I've ever witnessed. It was dehumanising.

(I saw/participated in a lot of CPR during foundation years too, just this episode was particularly memorable).

Knowing what I do, I can say with confidence that there was no possibility of somebody of his age and condition surviving an arrest. And what is worse, everyone present will have known this. It was obscene. He had to endure those last few hideous moments because he did not have a DNACPR. That meant that a decision to stop (or indeed not start at all) could not be made until a senior decision maker was present and made that call. Which is difficult to do once CPR has started.

I would never ever want to have CPR aged 85 with dementia. I would be fighting to protect my relative from CPR in this situation, making sure the DNAR is in their record. I think all HCPs who have actually witnessed CPR would say the same thing.

I'm so sorry your grandad is unwell, and that the communication was not more sensitive and upset you / him. Doctors are in a hurry, that's the state of the NHS. I believe your grandad's doctor is trying to protect him from futile suffering and indignity.

Is there an age to stop trying to resuscitate people?

I think you’ve misread the stat - she was saying that those who are resuscitated are young with a primary cardiac issue. Not that those were cardiac figures.

Of course not. You are just being antagonistic.

I thought you had decided to leave the post.

No. If course not. It's based on causing least harm and every person's circumstance is different.

No. Medical decisions are variable because not one situation is the same as another.

What part of this question do you think is a good contribution to the thread you said you were leaving?

I can see how you feel they approached this incorrectly, but he has had an unresponsive episode. They need to know what should happen tonight should he pass away, not wait until your mum is back in the country.
Your mum seems to be talking about withholding treatment when someone is alive, which is a very different thing. If a frail 85 year old dies there is no coming back from that. Even in the off chance they did get a pulse back, ITU wouldn't accept him, so you are just giving him a prolonged painful death with a few broken ribs. Much better to be allowed to go peacefully surrounded by family.

@Mum2jenny

no, not ageist, realistic & Do No Harm.

I’m not, I just think that some ppl will want to live for much longer than others. My dmil was wanting to die way long before her time, but she didn’t.

Futile CPR on folks that should NOT be resuscitated is not just awful for the patient but for the staff involved -it's not Holby City but a pretty brutal affair