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<p>I’ll give you a reason why I “wouldn’t have been upset by that phone call.” I wouldn’t want her last experience on earth to be a violent procedure which had virtually no chance of saving her. Is that one on your list of things I’d “dislike”?</p>
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<p>Elderly people who suddenly drop dead are not healthy and strong. The reason is rarely something fixable, it is because their heart has ceased to be functional or they have had a stroke which has so irreversibly damaged them that they cease to breathe or maintain a pulse. When CPR is withheld from someone in this situation, it is not because they are old and therefore not worth having around, it is because they are so old that it truly is a cruel exercise in futility and tantamount to abuse. Because your parents are healthy and strong, they would probably not agree to live in a place which has a no CPR policy. This woman’s daughter says her mother KNEW and was in agreement with it, so rather than being pleased as punch that her mother is dead, she is instead at peace with what occurred. Big difference, and until I know differently, I will not state that it’s “likely” she was more concerned about her inheritance than about her mother’s best interests.</p>
<p>When young people drop, it is often due to an arrhythmia which can be shocked back into a normal rhythm or converted with a drug. It is rarely because their heart muscle is essentially dead (not reversible), which is usually the case with someone pushing 90 years old. Making the case that CPR is not necessarily the humane thing to do is NOT the same as saying the elderly are not worth having around.</p>
<p>One thing this thread is showing is that we all draw the line at different places when it comes to end of life issues. And that is precisely why the default standard of care is that
people get life-saving treatment (leaving insurance issues aside, for a moment) unless there are explicit instructions to the contrary in the form of a DNR or living will. </p>
<p>As it is right now, I’m not sure that a DNR covers CPR. Given what some people have said in this thread, maybe it should. But that isn’t at issue here, both because it doesn’t sound like this woman had a DNR and because that isn’t what was motivating the employee’s actions. </p>
<p>And again, I really doubt that the woman was aware that the no-care policy extended this far. In fact, as the facility is now saying that the policy doesn’t, in fact, extend that far, it is almost certain that the woman wouldn’t have been aware of a policy specifically banning CPR - either it doesn’t exist, or the no-care policy is stated vaguely enough that the place can maintain plausible deniability.</p>
<p>The woman was still breathing when 911 was called. If she had been five years younger would assistance been given in lieu of an actual DNR?
Ten years?
Who decides whether or not to render assistance?
Should a bystander decide?</p>
<p>As far as CPR, I remember my CPR classes when the instructor said - when doing CPR on the elderly, if you don’t hear their ribs breaking, you aren’t doing it correctly. That stuck with me.</p>
<p>My mom is 92 and lives on her own in a condo. All her friends have died, she is in a lot of arthritis pain, her vision is poor. She is ready to go, and I hope she dies peacefully in her sleep and does not have an episode in public where people will feel compelled to try to prolong her life.</p>
<p>“I’ll give you a reason why I “wouldn’t have been upset by that phone call.” I wouldn’t want her last moments to be violent, with virturally no chance of saving her. Is that one on your list?”</p>
<p>Well, it is now.
I do realize that the press doesn’t always get it right, and that you can just get snippets of a quote. Who knows what exactly was said, or how the family really feels.</p>
<p>“This woman’s daughter says her mother KNEW and was in agreement with it, so rather than being pleased as punch that her mother is dead, she is instead at peace with what occurred”</p>
<p>As apprenticeprof just said, the facility is saying the policy doesn’t extend that far. They are completely backing down from acknowledging that. So how could the mother have been aware of that? Or perhaps the facility is lying just to cover their butts.</p>
<p>If the paramedics got there quicker, wouldn’t they have administered CPR and used the paddles on her if they thought it necessary?</p>
<p>Or maybe, busdriver, the children really didn’t want their mother to undergo a violent procedure which had virtually no chance of saving her. Maybe they really just did want her to go peacefully, because that was best for her. Is that not even a possibility in your book? </p>
<p>BTW, very elderly people are not hale and hearty. I’m glad your parents are healthy FOR THEIR AGE, but that is most emphatically NOT the same thing as being a healthy 50-year-old. Have you ever cared for a frail elderly family member? Just curious, because being in the trenches with them has a way of changing your outlook on just about everything, including the questionable value of CPR and other life-extending treatments. You begin to see peace, comfort, and dignity as the overriding goal, not longevity.</p>
<p>I suspect that the rehabilitative facility where my 75 yr old mom was staying after surgery for a few days, did not perform CPR on her when she choked on medication…
I was not privy to all the details, but if that was the circumstance, I would NOT be happy with that decision. ( since this happened, I looked up their care records & despite being expensive & a very posh building, their scores were very low & they were under investigation for several incidents)
In lieu of an DNR, I do not think it is the responsibility of bystanders to make that decision.
If it is, then why even call 911 if you reject their assistance?
There are ways to perform CPR on fragile individuals.
Our oldest came home from the hospital before her due date & before she weighed four lbs.
We were instructed on how to do CPR without injury, employees who work with fragile individuals can be instructed on the same thing.
Dont assume those living in nursing homes or assisted living are elderly.
Many times they are individuals with enough health problems that they need regular care, but could live for perhaps thirty or forty more years.
However govt aid & insurance often only pays if they are in an institution, it does not pay enough to have assistance for them to live at home.</p>
<p>" Maybe they really just did want her to go peacefully, because that was best for her. Is that not even a possibility in your book?"</p>
<p>If you weren’t so irritated with my posts, LasMa, you might have read where I responded to that question with, “Well, it is now.”</p>
<p>" Have you ever cared for a frail elderly family member? Just curious, because being in the trenches with them has a way of changing your outlook on just about everything, including the questionable value of CPR and other life-extending treatments."</p>
<p>Probably most of us parents on this forum have had experiences with losing and caring for elderly family members. My experiences have led me to support not doing extraordinary measures to prolong life for a short time, especially when people are in pain and will not recover. I am in favor of turning up the morphine and allowing people to pass peacefully.</p>
<p>But I didn’t think that CPR was an extraordinary measure. It certainly wouldn’t be for my parents, and along with emerald, I would not want bystanders to make that decision for my parents, just because they are elderly. From reading this thread, it does appear that CPR can be considered extraordinary for some people, which never would have occurred to me.</p>
<p>I am sorry about your mother, emerald. That must be very frustrating and upsetting, wondering what happened.</p>
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<p>In out of hospital scenarios that’s exactly what happens. There is no legal mandate to perform CPR, therefore bystanders DO decide whether or not to render assistance. </p>
<p>In THIS case, it was determined by the nurse dialing 911 that she could not make that determination (believes she is forbidden by policy from doing CPR) so she does nothing. She goes even further by refusing to even give any other willing bystander a chance to make their own decision. </p>
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<p>If someone drops at the grocery store, bystanders will of COURSE make that decision. They may feel they are not capable of doing it properly, they may be unwilling or physically unable, etc. They call 911 in order to get the pros there who DO know what they are doing. No one is REQUIRED to do CPR after calling 911 even if the dispatcher tells them to. Therefore, bystanders do get to make the call whether or not to initiate CPR before EMTs arrive.</p>
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<p>Yes, CPR is considered an extraordinary measure. When CPR is performed by professionals, there are chest compressions, mechanical ventilation with ambu bag which will then be advanced to intubation and mechanical ventilator, electrical shocks delivered directly to the chest, and numerous emergency drugs. What often happens to people in this situation who survive the initial injury is ending up in the ICU, unable to be weaned off the ventilator, often in a vegetative state, unable to eat, etc. Then you’ve got to start talking tube feedings, long term care, etc. OR now the family has to “turn it all off,” and if you think that is any easier for a family than agreeing on a DNR policy, you are mistaken. It’s often much more difficult for them to agree to this because now by virtue of “turning off” a machine which is keeping the patient alive, they feel THEY are “killing” their loved one.</p>
<p>Someone upthread asked if DNR meant no CPR. DNR absolutely means no CPR unless the patient has defined it differently. I’ve had patients that said go ahead and shock and try meds but no intubation. Or vice versa. Regardless, if it’s a full DNR, that doesn’t mean you don’t treat. You can institute support and comfort measures without doing CPR so that the patient is not just abandoned in a room with no response from the nurses and care team.</p>
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<p>It’s almost impossible to get good chest compressions on an elderly adult without causing injury. It’s not the same as with an infant. You can’t do it “gently” because the point is not to avoid injury, it’s to mechanically pump the heart in order to get blood to the brain.</p>
<p>It’s a sickening feeling to feel the sternum crack when you do CPR, but if you’re going to commit to doing it, you’ve gotta do what you’ve gotta do.</p>
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<p>In a medical facility staffed with licensed nurses, physicians, etc. a patient without a DNR should be given CPR if indicated. </p>
<p>Medical records can be obtained and you can find out if CPR was performed.</p>
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<p>Another thing it’s showing is that there is a great deal of misunderstanding about CPR, both its dangers and its efficacy. </p>
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<p>Regarding the idea that bystanders should have provided CPR if the aide wouldn’t – who were the bystanders in this case? They were other aides and employees of the facility, who were under the same rules. And they were elderly residents. Among those bystanders, who exactly was going to step in and perform CPR?</p>
<p>^^^^Possibly someone who was willing to risk their job.</p>
<p>I do agree with you that many seem to have a very unrealistic view of CPR.</p>
<p>The reason that CPR has such low survival rates is because people just don’t stop breathing and hearts don’t stop beating randomly. There is usually something very very wrong with the person and doing CPR and mechanically ventilating them, giving them drugs is rarely going to correct the underlying condition which has basically caused the person to die. CPR can sometimes successfully restore a pulse, but usually not for long. </p>
<p>None of which is to suggest that CPR doesn’t have value. It does, particularly with people who have healthy heart muscle and are merely experiencing a dangerous heart rhythm which is easily corrected or a blockage which is causing damage to a small area of the heart, are choking on an object or have had some kind of accident. In ACLS we are always coached on thinking about the cause of the arrest or cessation of breathing. Most of the reasons for cardiac and respiratory arrest in the extreme elderly are not going to be able to be corrected for any meaningful length of time, thus the absolutely DISMAL statistics relating to successful outcomes in that population.</p>
<p>Still, in the hospital, if there is no DNR on file and the person arrests, we are absolutely running a code. It’s a different story out in the real world and right now there is no legal mandate for citizens to perform CPR on a person who arrests.</p>
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<p>it’s not that complicated… it’s their (her) life… let them make the decisions they want.</p>
<p>What I find interesting about this thread is that the degree of outrage expressed tends to be inversely proportionate to the extent of understanding of the facts involved - success rate of CPR, the woman’s intent, etc. That’s far from unique to this subject. It seems to be a truism of modern American life that internet sources and the media give people just enough information to provoke their emotions without providing enough information and context to moderate that response.</p>
<p>Exactly, kluge. I’d only add that another factor which seems to fuel the outrage is a lack of understanding about Independent Living, Assisted Living, and skilled/subacute nursing – what services they do and do not provide, and the differences between them.</p>