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.

We lost my lovely MIL last year. She had dementia. The thought of anyone breaking her ribs performing CPR makes me want to weep.

CPR is violent. It would have been to no avail, and if by some miracle she'd survived it, the pain she'd have been in would have been horrific. She wouldn't understand and would have been massively distressed. It would have been absolutely cruel to do that to her.

Well yes. Isn't that the point. An elderly person who could easily break their ribs and doesn't have the quality of life or even the power to make their own decisions

Power of attorney not eternity!

Im probably very biased about this and wasn’t wanting to admit this much info.
But my dp was admitted as an emergency to A&E and had many further issues, including emergency surgery and a stay in ICU for a fortnight.
So I do know what I’m talking about. His prognosis was not at all good. But he is still with me.

POA means nothing in these circumstances, resuscitation is a medical decision and that decision will be made in the patient's best interest. You don't seem to have a clue!

And a care home?

And you had CPR in labour?

You have been incredibly unfortunate

Some people will want to live longer than others. That still doesn’t mean that CPR is an appropriate treatment to offer a patient where the overwhelming likelihood is that it will be futile and harmful. Just like if someone has terminal cancer and is so frail that aggressive chemotherapy would likely kill them and cause very distressing side effects doctors won’t offer them that aggressive chemotherapy either because it’s futile, harmful and hence inappropriate.
Any patient (who has capacity) can decide that they want to refuse CPR. No patient can demand inappropriate CPR. But DNA CPR decisions should be discussed with patients / power of attorney / family where possible and appropriate and their wishes should be taken into account when decision making - so if someone is frail / unwell but CPR is assessed as having a real but slim chance of success their wishes are key in deciding whether or not it should be offered. The tricky thing about CPR compared to other treatments is that you can’t discuss it with patients / families when the decision point happens, it needs to be started immediately for the best chance of success. So the default position is that everyone is resuscitated unless they have a DNA CPR form because that is considered less harmful than not resuscitating someone who should have been resuscitated. But it does mean these difficult conversations need to be had in advance.

Ok, your opinion, not the legal option

Also @Mum2jenny you don't get to be biased about this. It's not about you. OP had asked about her elderly relative. That's who it's about.

It is important to remember that CPR is not a treatment, not a cure. It does not usually reverse the cause of an arrest really, outside of the circumstance of suffocation/drowning or arrhythmia as an isolated problem (extremely rare). Usually, CPR just buys time to treat an underlying cause.

If you are for example, a young woman who has arrested shortly after giving birth, there are likely reversible causes. CPR will buy time for you to have a blood transfusion, or have a pneumothorax decompressed, a blood clot removed etc

But if you are 85 with dementia, and your urosepsis has shut down your weakened body to the extent that your heart stops... Or your COPD has progressed to the point your lungs simply can't work well enough any more... Or the cancer is now everywhere and the body cannot function, so that the heart stops... Recovery at this point becomes next to impossible even in the very short term. CPR in these types of circumstances, if it is successful, amounts to torture and is only buying time for suffering.

Whilst it is unfortunate that it was discussed at his bedside with him being able to understand, it is best IMO for him to have a DNR because he has dementia and is 85. It’s kinder for him. As well as ending up with broken ribs, people can end up seriously brain damaged because they were oxygen starved during resuscitation. As age increases, risks of resuscitation increase. And success rates of resuscitation go down.

it honestly would be better to die of a heart attack rather than be resuscitated and likely either face very nasty side effects and a painful drawn out death.

@Mum2jenny are you actually thick or just being obtuse, it is a medical decision who is resuscitated this is the law not my opinion!

Think of the little lad who was brain dead on a ventilator, his parents wanted him keeping alive, a judge laid down the law made the decision it was in his best interest for life support to be withdrawn!

At a guess your not in your 80’s with dementia

Resuscitation is brutal it’s not like on tele where they jump start them with shock and next thing there sat in bed chatting

chances are they’ll break many ribs cause loads of damage not to mention the risk of the brain been starved of oxygen and often yo frail to recover from this

Thought you were leaving? You are deliberately making this thread about you. First it was about your dh and then it was about you . Unless you are 85 with dementia then it has no relevance. At 85 we should be thinking about a DNR . Only the family and those close to op know how he would feel and what to do. Stop asking stupid questions.

Maybe just check they have all her wishes noted down. My DM had a "no taking to hospital" as well as DNR. She wanted to die in the home with support not the hospital.

There is absolutely no way I would allow CPR on an 85 year old relative of mine, especially if they have dementia. It's a brutal way to die, and not in their best interests. But I agree that the conversation should not have been had in front of your grandad

My mum had a DNR put on her file when she was mid 70s and having chemotherapy. She’s since had further treatment (for a different cancer) as well as some other medical problems. It’s not like she’s been left to die. But if she went into arrest or similar, she’d not want to be resuscitated. Maybe her attitude has been informed by her own mother having a heartbreaking 8 year descent into dementia until she died in her early 90s, an absolute shell of her former self. Was horrible to see.

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 agree. I've been matron of a dementia care home. If I got dementia I couldn't countenance the possibility of staff attempting CPR on me - or on anyone I loved, actually.

It isn't a question of ageism, either. It's a question of good, kind and realistic medical care.

No. I would perform CPR on a 90 year old who jogged daily, cared for themselves and was generally fit and well over a 70 year old with an advanced, life limiting condition. Age is only used for prognostication of success, not as a do/dont for CPR.

The person saying all adults should be DNR is ridiculous. Of course you should have been resuscitated!
I helped resuscitate a 60 odd year old man a few years ago who had a cardiac arrest in my presence, he's absolutely fine now.
Did have broken ribs and a long hospital stay though, so in OPs case I can totally understand why it has been suggested

But surely you would call her. I certainly would!

I'm not sure you actually understand

a) that this thread is not about you

and

b) what a POA means.

This. Excellently explained. Not giving CPR js not about deciding that someone’s quality of life is too poor for them to get a chance at living or that they’re too old for it. It’s about recognising that there is no chance of success and it will be a traumatic harmful treatment with no benefit.

This. DF had been miserable the last year of his life and had told me he's had enough. He had always said he didn't want to be kept alive unnecessarily, so when he was dying and the nurses said he would not be resuscitated I agreed and told them he didn't want it.

https://www.nhs.uk/conditions/do-not-attempt-cardiopulmonary-resuscitation-dnacpr-decisions/

This explains more.