reSPECT Suggestion

[SunshineSky81]

Afternoon All,

My lovely mum, 76 has alzheimer's and COPD. We are in contact with the memory clinic and nurses.

We were invited to a nurse appointment at the Doctors who said it was to introduce herself as a new elderly care / memory nurse. She took blood and urine , and went through general questions on mood and apatite.

While we were there we said that mum was starting to get quite significant swelling on her feet and ankles , the skin can either be white or a purple colour. She has also started bruising much more easily. I had put it down to thinning Skin and how skinny she is (around 5.8stone).

She suggested that we make a appointment at the Doctor - which we already have for next week.

After this, she brought up the reSpect forms and that we should make a appointment to get this done. On my understanding this is a notice that she would not want CPR in a emergency situation.

It is something we have talked about, and feel that her body simply would not recover from CPR, due to her weight and the damage on the lungs from the COPD. Add in the alzheimers i dont think it would be fair to prolong what is going to be a steady decline in health.

I was just a bit worried the way it was brought up after the feet thing, no one has ever spoke about this before. I know swelling in the feet can be caused by problems with the heart pumping blood which is a sign in end stage COPD. Am now wondering the way she said it and acted, it was like be prepared like she knew something.

Just wondering if anyone else has had this RESECT form offered by their doctor , and is it something that they do for everyone, or is mum sicker than i thought?

The RESPECT form is about more than CPR. It is really about finding out the wishes of the patient when there isn't a crisis and ideally having a conversation with carers and family so that everyone has an idea as to what the patient would wish to happen in the case of a deterioration.
The patient's views on resuscitation are part of it but also whether they put being kept alive as a higher priority than being kept comfortable. The form can be filled out further with details as to whether a patient would want to be admitted to hospital or be given antibiotics if these are things that they have thoughts on.
In my role I am often part of these discussions. Initiating resuscitation is a medical decision at the end of the day but it is really helpful to be aware of the patients views on their end of life care. If someone has dementia these questions obviously have to be asked while they have the capacity and comprehension to participate in the conversation.

Honestly... ask her. But more than likely it's just this month's policy push in her team, to have Respect forms discussed with a higher proportion of patients. I wouldn't worry particularly.

It's important to get this sorted out whilst the person is still relatively healthy. It gives you time to think about the implications and scenarios when you are not under pressure to make decisions.

I think once people get to a certain age or have a life limiting illness, it is standard practice to make sure this is in place, so it would be done at the first available opportunity, howsoever that arises.

I’m an elderly nurse and a respect discussion doesn’t have anything to do usually with a patients condition unless they don’t have one and are really ill in hospital and likely to deteriorate.

I hope it reassures you but it’s best practice for consultants to have that discussion at admission, even if someone came in with constipation or say dehydration, they’re probably not likely to die anytime soon but it’s good practice to have that discussion due to then having frailty needs or multiple co morbidities. I hope I’ve worded this ok and that it will reassure you that it’s not always due to anything other than trying to do it at a good opportunity

Thank you all for your replies. I'm glad to know i was over thinking, i can see why it would be a good idea, and mum and i have had conversations about it, but can see why it would be good to get her wishes logged down with the Doctor.