A study, published in BMJ Supportive & Palliative Care, found that one in five older, sick patients are recorded as “do not resuscitate”
The study, looking at the medical records of 481 patients aged 65 and older, found that only one in five older, sicker patients were marked “do not resuscitate”.
The findings, collected in 2017, suggest that even though these individuals are at high risk of cardiorespiratory arrest – aka when the heart and breathing stops. On such vulnerable people, resuscitation attempts are normally invasive and sometimes unsuccessful.
The authors further commented: “These findings indicate a low rate of decision-making about the use of CPR other than in the context of an acute admission.
“Older patients with multimorbidity are not only at increased risk of receiving CPR but also high users of healthcare. It is therefore likely that many opportunities to address the issue of CPR in the non-acute setting have been missed.”
Did anybody change their DNR decision?
Discussions about CPR took place on the ward for 48 (13%) of the remaining 376 patients: 16 of these discussions were with patients alone; 30 with relatives alone; and two with both.
These resulted in an additional 43 DNACPR decisions. An additional two decisions were made without discussion, both of which were for patients with severe cognitive impairment whose relatives weren’t available.
How many people died?
Nearly 1 in 10 patients died. All but one of these had a DNACPR decision in place. But most of these decisions had been recorded during the hospital admission: 8 in the emergency unit and 12 on the acute medical ward itself.
Among the 20 dead patients whose DNACPR decision was recorded during their admission, the average time from the decision to death was 4 days with 35% made the day before the patient’s death.
“Potentially undignified procedure”
They further commented: “CPR is an invasive and potentially undignified procedure from which older patients with multimorbidity are unlikely to have a good outcome; most older patients who receive CPR in hospital die before discharge.”
“This…is only likely to come about by education of doctors and by education of the public so that all concerned understand the reality of CPR and the need to discuss its role well before it is needed.”