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]

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

I have nursed people with dementia, and IMO they were far happier than the staff who took care of them.

[cherry*135]

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

Agree. A person in the latter stages of dementia, may not have much quality of lif eleft, but someone who is in the earlier stages does.

[i-once-was-bump]

There are lots of people in nursing homes who are reasonably healthy and have a lot more years to live

Well why then are they in a nursing home?

A person in the latter stages of dementia, may not have much quality of lif eleft, but someone who is in the earlier stages does

As this is about residents in NHs then surely those in the early stages of dementia would not be in a NH but those in the late stages would be far more likely to need NH care and this would be the people that need a decision about their life made in a matter of seconds if no previous preferences had been recorded.

My father had vascular dementia and it was not slow and gentle road to full on dementia but more a rapid decline followed by periods of stability and then weeks of losses of parts of his brain function and then a stable period. This stop start harrowing road left my father very confused and fearful and it was his heart that gave out in the end but that heart attack was caused by a brain stem stroke. No one should be revived from that sort of situation.

Some say doctors and families are playing god but for those that do believe isn't it god that took away the life so who are we to force our medical knowledge on someone who has died?

Do we really have the right to keep anyone alive after they have actually died?

[azureline**]

There are lots of people in nursing homes who are reasonably healthy and have a lot more years to live

Well why then are they in a nursing home?

A person in the latter stages of dementia, may not have much quality of lif eleft, but someone who is in the earlier stages does

As this is about residents in NHs then surely those in the early stages of dementia would not be in a NH but those in the late stages would be far more likely to need NH care and this would be the people that need a decision about their life made in a matter of seconds if no previous preferences had been recorded.

My father had vascular dementia and it was not slow and gentle road to full on dementia but more a rapid decline followed by periods of stability and then weeks of losses of parts of his brain function and then a stable period. This stop start harrowing road left my father very confused and fearful and it was his heart that gave out in the end but that heart attack was caused by a brain stem stroke. No one should be revived from that sort of situation.

Some say doctors and families are playing god but for those that do believe isn't it god that took away the life so who are we to force our medical knowledge on someone who has died?

Do we really have the right to keep anyone alive after they have actually died?

Nursing homes are there for people who can't, or don't want to, live at home alone. Some families are not equipped for it. Some have no family etc......

Sometimes they are in there in the early stages to settle into it, to become comfortable there before they forget who they are and where they are.......it appears to slow down the dementia.

No one should be kept on life support or revived if there is no quality of life or no expectation of recovery, imo.

[cherry*135]

As this is about residents in NHs then surely those in the early stages of dementia would not be in a NH but those in the late stages would be far more likely to need NH care and this would be the people that need a decision about their life made in a matter of seconds if no previous preferences had been recorded.

It is not safe for some elderly people in the early stages of dementia to remain in their own homes. They may still be able to dress themselves, read the newspaper etc, but they may also be forgetful and not turn the stove off or heaters off. Not be able to focus on normal household tasks like doing their washing.

There are secure units (for people in later stages of Alzhiemers) and non secure units.. where residents may have early stages of Alzheimers or may be in there because of physical incapacity only, have had strokes etc.

The home where my mother is, if she started wandering off, or getting aggressive etc, she wouldn't be able to stay there  and would have to go elsewhere to a secure unit.

[polksaladallie]

There are lots of people in nursing homes who are reasonably healthy and have a lot more years to live

Well why then are they in a nursing home?

Sometimes it is because the children do not want the bother of caring for them.  Too selfish.  Australia has the reputation of being one of the worst countries where elderly parents get dumped.

[bright.ton42]

Well why then are they in a nursing home?

Where else to go if they have no family to care for them and they live alone?

I would honestly like to know as I have no family to care for me if something

should happen to me that precludes me staying at home. 

Off to the nursing home I would have to go, like it or not.  

[cherry*135]

My cousin (a nurse) had her Mum live with her for a year before Aunt needed around the clock care in a secure dementia unit. She visited her at least once a day, not everyone dumps their parents in a home and forgets about them.

My cousin worked, even if she didn't thoughm she realised that she (and her OH) couldn't give the care Aunt needed.

[azureline**]

Well why then are they in a nursing home?

Where else to go if they have no family to care for them and they live alone?

I would honestly like to know as I have no family to care for me if something

should happen to me that precludes me staying at home. 

Off to the nursing home I would have to go, like it or not.  

Some of them are lovely, start looking now and write a directive . I have found one for my fil that is perfect, resort like but homey, beautiful place. I think we are going to buy a unit there ourselves within the next 10 years.

Just waiting for a vacancy for Dad now.

[cherry*135]

Sounds good az. Nice when those places have a homey feel to it. The one my Mum is in does.