Many in Aged Care Allowed to Die Peacefully without CPR

[grandmoon]

Most nursing home managers and staff do not support giving cardio-pulmonary resuscitation to elderly residents who suffer heart attacks, and the technique has been found to be ineffective in reviving most.

While the policy of most nursing homes is to administer CPR, a survey of managers of the homes by Dr Bill Silvester, who heads the Respecting Patient Choices program based at the Austin Hospital, found fewer than one in five thought heart attack patients should be revived.

The reality was that in three-quarters of the homes no CPR was used in the past year, and in the few where it was, it was used only once, Dr Silvester said. ''It would appear that frequently residents were found deceased or were known to be dying and were allowed to die peacefully"

The results of the study prompted calls for new national guidelines on when CPR should be used.

Dr Silvester said in his analysis of the study findings: ''We would also recommend that guidance be provided on when and how to discuss this with residents and their families. NSW Health state that it is reasonable to withhold

CPR without explicit discussion with the patient or family if a) the resident or family do not wish to discuss it, b) the resident is aware that they are dying and has expressed a desire for comfort care or c) the facility does not provide CPR as a matter of course, consistent with the values and practices relevant to its population.''

Of more than 400 managers surveyed, fewer than 20 per cent thought CPR should be used in cases of ''witnessed cardiac arrest'', despite four out of five homes surveyed having a policy of providing CPR if the need arose.

''This revealed a significant difference between what the staff thought would be appropriate for their residents and what they were expected to do,'' Dr Silvester wrote in the report.

He cited international studies showing that on average fewer than 1 per cent of residents who had heart attacks and were given CPR survived and returned to the aged-care ho me.

He said the use of CPR on aged-care patients appeared to be driven by an expectation of what medical staff needed to do, rather than its effectiveness. ''The reason we did this study was we were appalled at the number of elderly people being resuscitated in aged-care homes and being brought into hospital and ending up in the intensive care unit.

''So we asked the ambulance people why this was, and they said they had no choice. And then we asked the nursing homes and they said it was because of expectation.''

The findings come on the eve of a conference in Melbourne on planning end-of-life medical care.

Read more: http://www.theage.com.au/national/many-in-aged-care-allowed-to-die-peacefully-without-cpr-study-sugg...

[polksaladallie]

I'm not sure how I feel about this, Grandmoon.  There are lots of people in nursing homes who are reasonably healthy and have a lot more years to live.

I do know that a lot of the staff are not trained in nursing even, I wonder if they have CPR training.

To ask you (on the same topic), did you see an item on TV about a low level care area of a nursing home in USA, where a resident had a heart attack, rang 911, the operator began to talk them through CPR, and the nurse said they were not allowed to do resuscitation in that area.  They simply refused because of the regulations.  The operator was frantic, asked if the nurse would go outside and get a gardener, or someone off the street, or the woman would die.  Too much time passed, and the woman surely did die.  I was horrified.

[grandmoon]

I understand how you feel, I was think about my parents who died Dad was 86 and Mum was 91.

At their age and their health I would have been very angry if they had been resuscitated.  When mine next door neighbour died he was in his nineties and for the last 18 months of his life he was saying "why am i still here" yes he was ready to died.  But after his death 2 of his sons was angry with their sister and the Doctors for not doing more to keep him alive.

A lot of the  patients have already have their medical records marked "Do Not Resuscitate" so I feel that their wishes should be respected.

[polksaladallie]

I understand how you feel, I was think about my parents who died Dad was 86 and Mum was 91.

At their age and their health I would have been very angry if they had been resuscitated.  When mine next door neighbour died he was in his nineties and for the last 18 months of his life he was saying "why am i still here" yes he was ready to died.  But after his death 2 of his sons was angry with their sister and the Doctors for not doing more to keep him alive.

A lot of the  patients have already have their medical records marked "Do Not Resuscitate" so I feel that their wishes should be respected.

Of course, but if they do not have that in place, who makes the decision on the spot?  There are no doctors there, no time to ask relatives.

[catsnknots]

The damage done to a person receiving CPR is pretty full on.. cracked ribs and bruising... it can leave a person in pain for a very long time...  ok if you have good life ahead of you but when you are at the end of your life do you really want to be holed up in bed with cracked ribs that will probably never heal properly before your die??? 

I would encourage everyone to have one of those do not resuscitate things written up... someone here has told me what they were called before.... I just can't remember. 

[polksaladallie]

Advanced Health Directives.

[azureline**]

Family were asked last week if they wanted my FIL to be resuscitated if he should require it during surgery he may need. He has no care plan as he has dementia.

At first they said no.... a day later decided yes.

Today, we spoke about the surgery with him, with the doctor present and he quite clearly knew what he was being asked and he said yes, he is able bodied and still functions. They did discuss the broken ribs etc.

[catsnknots]

Advanced Health Directives.

that's it... 

thanks... one day i will remember it.. lol 

[punch*drunk]

My grandfather had several heart attacks 6 months ago, luckily they werent severe enough for him to need resuscitating, they put a few stents in and now he's good as gold.

I think there would have to be other health, physical or mental, issues that would need to be taken into account when deciding to resus or not. My gandpa is 91, but he is fit and strong and still sharp as a tack, he's not ready to go yet.

It would be different if he had other illnesses or dementia.

[azureline**]

Dementia does not mean no quality of life, they have windows of dementia and sometimes bigger windows of normalcy.