dnr in geriatrics

Sometimes family just will not accept that their loved one is end-stage. I have one who is stable now but last month sent out with a BP 60/25 Agonal breathing. Intubated by EMTs before he left. Quality of life....end stage Alzheimers, total care, nonverbal, poor appetite, the works. Not how I would want my life to go. Some day maybe we can differentiate between being alive and living and make the public see the difference. Now I'll take off my rose colored glasses.

I see this a lot in the hospital I work with a large geriatric population. One that comes to mind was just sinful. Family was in total denial. multiple admissions, discharges, the poor dear was suffering so badly. Family ended up taking her to another hospital where the Department of Elderly Affairs/Abuse was called in. I don't know the outcome of that but the poor dear passed on last week...finally in peace and not suffering any longer.

It makes me ill when people don't know when it's time to give it up. My father-in-law died recently and to us the choice to make him a DNR was not hard at all. It got to the point it was harder to see him "living" in the shape he was in. When he went unconscious from a fall and we sent him to the hospital we later got a phone call from the doctor who told us he had massive bleeding and they "could" do surgery but it wasn't advised because he was going to die anyway.

So, we allowed them to put him on the hospice unit, started giving him morphine and let his body shut itself down. He died a couple of days later. We felt bad at first but they assured us we were doing the right thing and looking back we see it was a blessing.

I see patients in the nursing home hanging on by a thread and about half of them are full codes. It is ridiculous.

It's usually the families that won't allow the DNR. Too many think it = "leave them in a corner to die". I spend A LOT of time correcting misconceptions about this.

when i workd med/surge, we would get pltany of nursing home pts and no dnr's, it would be awful to see these poor pts barely breathing. yet the family wanted everything done.

had one doc tell us one day "you can't fix 97". he would always ask the family about a code status and explain it very well too.

too many times these poor pts had to endure needless test and procedures because of the family's denial. this country needs to become more educated on how the body prepares itself for death. death is a taboo it seesm and most people ( my thoughts only) do not want to face the end of life, much less discuss it.

sorry to ramble but i understand where you are coming from.

Well Dr's cannot just perscribe a DNR...at least not in most cases. I aggree with the pp, it is usually the family that you cannot bring out of complete denial. We see this all to often, and unfortunatley there is really nothing that we can do besides try to educate!

We had a guy who had a dx of CVA, ESRD, COPD, was bedridden and could barely communicate. Naturally, he was a code. His POA was his son who lived a thousand miles away, and NEVER came to see him. This poor man arrested, and all of the heroics applied. He ended up LIVING, on a vent and PEG tube. The MD tried and tried to talk to the son about making his Dad a DNR without success. Finally, the MD took his case to the ethics commitee at the hospital and they somehow overrode the son's decision and the man was taken off of life support, and he mercifully passed. Some families are sooooo hell-bent on keeping their loved(?) ones alive they fail to see the suffering they have to endure. Living wills are no good, either. As soon as the person loses consciousness someone can step-in as POA and override the will. At least they can here. MD's will do as the POA asks, they have no real say in what code status their pts are. I do believe educating the families better about what each option is would benefit pts. The biggest misconception I've heard is that people tend to think DNR is synonymous with "Do Not Treat". If we could find a way to get the truth out there, our code pts wouldn't have to suffer so much.

Unfortunately too there are families who keep their family member alive at all costs as pay back for old wounds, physical and emotional. I've seen that recently and while I can understand at some level, it still bothers me.

:crying2:I see a lot of families not ready to make that decision..or they think they DNR means do not treat (things like UTI, URI whatever) Most times that simple explanation is enough. Some families need a rather blunt explanation of what happens when CPR is performed, with others phrasing it as letting "nature take its course" and they are more than willing to sign the OOH DNR. I've never known a family to want their loved one to keep on living a horrible situation as "paybacks".

one of the most preciouse memories I have is a family, 2 brothers caring for mom. Mom got to the point where she wanted to "let nature take its course" (her words) One son said "Whatever you want" the other had a lot of difficulty with that. this family had NO arguing, they talked it out over the weekend (mom and sons together) and decided together to let nature have her way. Through the next week they all spent time together, sons, DIL, grandchildren laughing, remembering, crying and saying goodbye. Amazing to watch the whole process, and I've got tears in my eyes just thinking about it.

I have recently run into an entirely different situation at work. We have a 97 y/o woman who was admitted with a hip fx. She has some confusion, but otherwise seems to enjoy her life. Her hip has since healed, but she has chronic pulmonary issues. Her last labs indicated a poss. UTI. The POA has up and decided she does not want her treated anymore. No meds, no tx's, no ANYTHING. She said her Mom has "been trying to die for a long time" and wants to let her go. Now mind you, this lady sits there grinning all day and is as pleasant as can be. She was on hospice months ago, but was "let go" because she was doing very well, and still is. I am confused as to what the rules are on that one, and passed it off to someone with more knowlege. I would rather think what she wants amounts to neglect. I hope things work out well for her, but I don't think I could live with myself if I was "made" to withhold tx's/meds from her. I would resign first.

We have the same thing, kind of, at the facility I work at. "Mom" is a DNR, and apparently has some money left. She is a DNR, and in very bad shape. For 77, you'd think she was 97. Anyway, she has no quality of life, but her POA is mad at us for feeding her. They want us to stop feeding her. Mind you, she eats by mouth - but has to be fed by staff.

But still. How cruel is that?

I can see both sides of the issue. I have seen people end stage brain cancer and the family still refuse him to be a DNR. Another example was a woman who before her stroke was lively and would look at people who are just laying around like lumps and shake her head and say she would never want to be in that shape. Well. lo and behold, she had a massive stroke that basically left her paralyzed and she was unable to speak or move. Instead of letting her pass, her sister decided to put a g-tube in as she was the POA. You can see it in her eyes she is alert and able to understand what you say and she moans out and cries a lot. All she does is lay there like 3rd base. I know that is not what she would have wanted as she has 0 quality of life.

On the other hand , several times I have called MD's about a resident and the first thing they ask is what is their code status? Hello! They have pneumonia/flu (or whatever). Something that could be treated with ATB or maybe they just need a breathing tx or two. If they are terminal I could see that but sometimes MD's cause part of the problem too by just brushing them off ("well they ARE 80 or 83" etc.). I think it is about quality of life. If the person no longer has a potential to have any quality of life why let them linger and suffer?