This question came up when we were making decisions about my dad’s end of life, and whether we should put a DNR on him. The doctor gave me a fact sheet about CPR in frail elderly. First, it has a 0-5% chance of successfully restarting the heart. If it does restart the heart, the patient will certainly have broken bones (which is a huge problem with elderly), probably brain damage, and very possibly internal laceration of organs. The loved one is not going to go back to their previous life. Best case, they will be hospitalized/confined to skilled nursing for a very long time, in pain, undergoing constant medical interventions, with reduced mental faculties compared to before the episode.
And, as a friend said, in the almost certain event that it doesn’t restart the heart, your loved one’s last experience in this life will have been a violent assault. That was what made the decision for me. I wanted my dad to go peacefully.
Based on everything I’ve read and heard from doctors, resuscitation of the very elderly is a terrible idea all the way around.
I agree but my dad has insisted loudly every time the matter has come up he wants EVERYTHING and a code called on him to keep him “Alive” as long as possible. My older brother and sister will see that his wishes are honored.
More and more health problems are cropping up as my folks are reaching 87 and 92. I can see this being a very long period of decline and loneliness and irritation/frustration that they can’t do what they want and used to
That friend who had the thought about the violent assault – he had been through this with his mother several years prior. When Dad was dying, he was tremendously helpful to me in sorting out thoughts, feelings, ethics, family considerations. But the single best thing he said to me about it was actually back when his own mom was dying. I had asked him how it was going, and he said, “At this point, we’re just hoping for a soft landing.”
A soft landing sounds much better than a brutal, violent assault, CPR. Sadly, many do not have soft landings, especially when the “kids” disagree about the best course(s) of action.
We kids played death panel with FIL, he is in his 90s and weakening, he has been running to every doctor, nuclear stress tests, ER visits for weakness, many specialists, all because he is fading, weakening and afraid. We finally had to basically do an intervention. He was wasting his time & limited energy, stressing his psyche, getting no improvements, and wasting a ton of money. We got him onto hospice and that is much better, he is so happy to have people who just want to know how he feels. He likes going over all his complaints and having them addressed and not going to the ER all the time and all the doctor visits is saving him a lot of energy that he did not have to waste.
@SplashMom , I am so sorry for your loss. Condolences to all who have posted about their losses.
My mother died a terrible death, and we were fortunate that she had put very specific things in her advanced directive and had a DNR … and we knew where they were, so we could bring them to the hospital (even though they had been given the papers on a recent visit, they had to have them every time she was admitted). It made it easier (if you can call it that) to tell the doctors that they could not do x, y, or z. I have not put things into place like I should - this is a good reminder. We have discussed it at length - H, our kids, my brothers - but things do need to be in writing.
The ethics of end of life are difficult. We don’t want to discount the value of the life, but we need to respect the fact that none of us lives forever … and we are sometimes more humane to our animals than we are to our fellow humans.
@HImom, FIL was the same way. After a few round trips between the hospital and the rehab facility, the doctor finally cornered BIL and told him FIL was not competent to make a decision, and BIL, who was the official health care proxy, needed to be the one that made it. We never had a dementia diagnosis or evaluation on FIL, but the doctor figured out his lack of cognitive capacity. FIL thought, until the end, that if we would just hand him his keys he would walk out to the car and drive home. Sad that he could not have the kind of dialog with his kids that recognized that the end was near, but maybe he needed that hope to cope with the daily pain and indignity of his conditions.
Condolences to everyone for their losses. My parents both had reasonably good deaths. They both had had several years of demenitia before they passed away. In my father’s case he simply lost his short term memory, but he actually became nicer and nicer as he faded away. He had some falls and was gone in a week. He had in-home hospice for the last few days of his life. My mother had a different sort of dementia, that she was quite aware of and often talked about what it was like. (She had very harmless visual and aural hallucinations.) She also had a really hard time with time and the calendar, which really affected her ability to take all the pills she was supposed to take. Like my father, she had a fall after a very minor trip to the hospital and then had about a week of hospice at home. (She lived with my brother.)
They had both made very clear what their wishes were. And all of us siblings were on the same page.
This hits a sore spot. I hated the way my Mum’s last few years ended up. She was so very unhappy and it hurt to see my lovely Mum that way. Wish she could have stayed in her beloved home like she wanted to and died while she was still herself. The last 3 years I hoped each time I saw her (not as often as I wish as she lived in England) that I would get a glimpse of “her” were just heartbreaking. My Parents in law as well. My MIL had a DNR but they would keep treating her pneumonia that she got often. She was in pain and the pneumonia would have been a kinder way to go. Her last days she was crying and begging my SIL to help her because the home was scared to give her pain meds that would maybe suppress her breathing. Ugh.
I think my Dad was and grandparents were lucky that their dying was not prolonged. .
Some people are hesitant to sign a DNR because they incorrectly think that means “Do Not Treat” a DNR means Do Not Resuscitate . That means if you stop breathing and /or your heart stops do not initiate CPR or use advanced technology to prevent death. People also mistakenly believe that a DNR is not revocable . A person or advocate can revoke a DNR. Also , a living will is where one would document what they want as end of life measures like pain management , nutrition , hydration etc.
I’ve noticed that many of my fellow nurses who have worked ER or ICU feel very strongly against extreme measures if and when the time comes. When you’ve taken care of people on ventilators who really have no hope of recovery, you can form very strong feelings against that being inflicted upon yourself. And that goes for feeding tubes as well.
This thread is a good reminder to put my wishes in writing. I think I’m going to look into having a living will done. My parents are the do everything possible type. My mom wants to be kept on life support indefinitely and my dad is also against pulling the plug (“what if xyz happens?!”). I don’t know if they’re in writing but I will honor those wishes if it ever comes to that. Myself, on the other hand…nope.
There is a big difference between being in a ventilator and having a feeding tube. Many people who can’t take in adequate nutrition orally can have a PEG feeding tube put in and live for many years with normal quality of life.
Yep, HImom. And there’s also the problem that medicine often isn’t black and white in the way that legal documents are, especially when dealing with an elderly patient with a host of complicated problems. Doctors don’t have crystal balls. Diagnosis can be elusive, prognosis uncertain, treatment ineffective, all of which makes decisions even trickier.