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...
