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Dnr

Bha

Registered User
Jun 17, 2020
36
0
My mum over lockdown has been in a care home and has Alzeimhers. She is wheelchair bound as she had 2 falls where she broke her femur bone initially and then her hip. Consultants have said no surgery as high risk and for her to live out her days. This is not the life we planned for her after losing my dad just over 2 years ago. She is not eating and drastically losing weight. She may have to go to hospital and be put on a drip which will upset her even more. The care home have asked us about dnr. We are so torn. What do we do. Poa in place but it's a really difficult decision. She is diabetic and so frail. We as siblings don't know what to do about consenting to dnr. It's so hard. What kind of life would she have if she was resuscitated.
 

silkiest

Registered User
Feb 9, 2017
280
0
Hi @Bha, DNR orders are signed by a Dr, there would need to be one in the care home and a new one would be needed for the hospital if she was admitted. Do you know who her GP is - would it help you to discuss the pros and cons with the GP.
If there is no DNR in place then the home staff and ambulance staff etc are legally obligated to start CPR and continue until she has been pronounced dead by a Dr. Some relatives find the thought of CPR on their dead relative distressing, so the decision is difficult either way.
Bear in mind if you don't want to make the decision you don't have to - the doctor can make medical decisions 'in the best interests of the patient' and take that responsibility off your shoulders.
 

canary

Registered User
Feb 25, 2014
14,980
0
South coast
Hi @Bha

My OH has a DNR. It doesnt mean that they will not do any treatment, it just means that if his heart stops beating, they wont try and start it again.

Resuscitation is not like you see on TV. It is brutal and often involves broken ribs. Even if the heart is started again, often the shock of the procedure and the pain means that frail elderly people do not survive long afterwards anyway.
What kind of life would she have if she was resuscitated.
I think this says it all. Much better to let them pass away naturally.
 

imthedaughter

Registered User
Apr 3, 2019
603
0
What kind of life would she have if she was resuscitated.
Oh dear this is always a terrible choice. My dad had been in his residential home for a few months and absolutely played a blinder on a locum dr who came round to see him. This dr listened to Dad and a carer, and Dad was on such good form the Dr said he had capacity. He then asked dad about DNR, and because dad thinks he's at the start of his military career, obviously he said no to a DNR!

This has since been reversed. Dad told me earlier in his life if he got dementia to shoot him, and while I don't think I'll be doing that, I did put a DNR in place later on when Dad was deemed to not have capacity. My best friend's dad was successfully resuscitated when we were teenagers, twenty years ago (and he was younger than my dad to start with!) It was incredibly hard for him to recover, he must have been in his 50s or 60s at the time, and in fact he died a few years later.

Resus doesn't often work, and it is not well tolerated and is physically destructive to the frail. It's your decision but I decided it was kinder to let dad go, if he goes. We have agreed, also, to have a case by case review, so dad will not be taken to hospital unless it's absolutely necessary, e.g. no tests or investigations for something small, but if he fell and broke something then yes of course.

If mum is not eating, is it by choice, through stress or illness or is she not needing food any more? I don't want to shock you, but sometimes people get hospitalised for not eating when actually they are at end of life and have stopped eating because of that. This is really hard to ask but can you ask someone who cares for her if they think this is the case?
 

Bha

Registered User
Jun 17, 2020
36
0
Hi @Bha, DNR orders are signed by a Dr, there would need to be one in the care home and a new one would be needed for the hospital if she was admitted. Do you know who her GP is - would it help you to discuss the pros and cons with the GP.
If there is no DNR in place then the home staff and ambulance staff etc are legally obligated to start CPR and continue until she has been pronounced dead by a Dr. Some relatives find the thought of CPR on their dead relative distressing, so the decision is difficult either way.
Bear in mind if you don't want to make the decision you don't have to - the doctor can make medical decisions 'in the best interests of the patient' and take that responsibility off your shoulders.
 

Bha

Registered User
Jun 17, 2020
36
0
Silliest, thank you very much. Very informative. I will share with my siblings.
 

Bha

Registered User
Jun 17, 2020
36
0
Hi @Bha

My OH has a DNR. It doesnt mean that they will not do any treatment, it just means that if his heart stops beating, they wont try and start it again.

Resuscitation is not like you see on TV. It is brutal and often involves broken ribs. Even if the heart is started again, often the shock of the procedure and the pain means that frail elderly people do not survive long afterwards anyway.

I think this says it all. Much better to let them pass away naturally.
 

Bha

Registered User
Jun 17, 2020
36
0
It's such an awful decision and we have all been really upset about but I dont want her to suffer anymore than she already is. Thank you for the info.
 

Bha

Registered User
Jun 17, 2020
36
0
Oh dear this is always a terrible choice. My dad had been in his residential home for a few months and absolutely played a blinder on a locum dr who came round to see him. This dr listened to Dad and a carer, and Dad was on such good form the Dr said he had capacity. He then asked dad about DNR, and because dad thinks he's at the start of his military career, obviously he said no to a DNR!

This has since been reversed. Dad told me earlier in his life if he got dementia to shoot him, and while I don't think I'll be doing that, I did put a DNR in place later on when Dad was deemed to not have capacity. My best friend's dad was successfully resuscitated when we were teenagers, twenty years ago (and he was younger than my dad to start with!) It was incredibly hard for him to recover, he must have been in his 50s or 60s at the time, and in fact he died a few years later.

Resus doesn't often work, and it is not well tolerated and is physically destructive to the frail. It's your decision but I decided it was kinder to let dad go, if he goes. We have agreed, also, to have a case by case review, so dad will not be taken to hospital unless it's absolutely necessary, e.g. no tests or investigations for something small, but if he fell and broke something then yes of course.

If mum is not eating, is it by choice, through stress or illness or is she not needing food any more? I don't want to shock you, but sometimes people get hospitalised for not eating when actually they are at end of life and have stopped eating because of that. This is really hard to ask but can you ask someone who cares for her if they think this is the case?
 

Bha

Registered User
Jun 17, 2020
36
0
We had a chat last night and cried too. I hope my mum doesn't go into hospital as that will upset her even more. There's the language barrier and the isolation. No one from the home have said she's on end of life care. My brother and his wife are visiting her today and going to encourage her to eat. I've not managed to visit yet as there are 4 of us siblings and only 2 designated people allowed. Its so frustrating. I imagine if she was on end of life care, they would allow access for us to see mum 😪
 

Jessbow

Registered User
Mar 1, 2013
3,522
0
West Hertfordshire
My mother ( now late mother) was resusitated. Never ina million years should she have been. She was black & Blue and in terrible pain.

She was in hospital at the time, with a heart condition. She had been asked and yes, she wanted to go ahead with a heart op- she should never have been asked- she didnt have capasity . I was furious- my father had the same op some years before and she would never have managed the recovery.

But

they had asked her and ( apparently) she had the right to choose to have it.

On the morning of surgery she was taken for a shower, and collapsed on the floor, Given CPR and the op subsequently cancelled. By the time she has started to recover, the decision had been made that it was a silly idea.

All that pain & discomfort, recovering from the CPR, to die just a few weeks later.
 

Bha

Registered User
Jun 17, 2020
36
0
Jessbow I'm so very sorry your mum went through that and for your loss. That's horrendous!! The message I'm getting is to consent to the Dnr. I was at such a loss with this. You always wonder whether you are making the right decision. I'm so grateful for everyone comments.

I've cried and agonised over this but when my mum has suffered enough, I dont want her to go through anymore but I'm not ready to lose her and don't want her to give up. You can have a normal conversation with her on video calls. The isolation and lack of eating is upsetting.
 

lollyc

Registered User
Sep 9, 2020
212
0
I have a friend who works in ITU. Notwithstanding the brutal nature of resuscitation , it has a very poor success rate, even in younger people. A DNR doesn't mean that your mother won't be treated, simply that they won't restart her heart if it stops.
Is your mum able to discuss what she might want? Mine completed an Advance Decision a few years ago. She stated she doesn't want to die in hospital, and doesn't want to be become a vegetable (her words), and that she understands that refusal of treatment may shorten her life.
Please don't feel that you are in some way signing her death warrant - you are making a decision in the best interests of your mum, and one that may never need to be invoked anyway.
You can only do your best, and with dementia that is very rarely what you hoped it would be.
 

Bha

Registered User
Jun 17, 2020
36
0
I have a friend who works in ITU. Notwithstanding the brutal nature of resuscitation , it has a very poor success rate, even in younger people. A DNR doesn't mean that your mother won't be treated, simply that they won't restart her heart if it stops.
Is your mum able to discuss what she might want? Mine completed an Advance Decision a few years ago. She stated she doesn't want to die in hospital, and doesn't want to be become a vegetable (her words), and that she understands that refusal of treatment may shorten her life.
Please don't feel that you are in some way signing her death warrant - you are making a decision in the best interests of your mum, and one that may never need to be invoked anyway.
You can only do your best, and with dementia that is very rarely what you hoped it would be.
 

Bha

Registered User
Jun 17, 2020
36
0
Hi lollyc. You've got it one. It felt like a death warrant and I'm grateful for the explanation of dnr as I wasn't aware if it's only if the heart stopped. I don't want to put my mum through anything else. She's half the woman or probably even less with the loss of my dad. Things went downhill when he passed. away and that was quite sudden in his sleep. We will not ask for mum to be resuscitated as I don't think her body will take it. Its just when you are faced with that question, you feel you're going to lose her anyday now. Frightening and upsetting. Xx
 

Lawson58

Registered User
Aug 1, 2014
2,331
0
Victoria, Australia
My husband had a cardiac arrest at home when he was 73 years old. He had been unwell for many years with his heart and was going through an asessment for Alzheimer's at the time though still undiagnosed.

At that moment, I never felt that I could stand by and let him die so I gave him CPR for almost 10 minutes before the paramedics arrived. It was a shocking experience for me but he never remembered anything about it. I broke his breast bone and knew I had because I heard it crack very loudly. He was very ill for many weeks and he never could understand why his chest hurt so much.

He split his head open when he hit the floor so there was blood everywhere and by the time they got him off to hospital, the kitchen looked like a battlefield.

He was fitted with a defibrillator so I won't be faced with that decision again. He is now 81 years old and though his physical health is failing, he has been a high functioning person with dementia until recently.

I do not regret for one moment my actions then but that was then and now is a different world and a different life. I believe that now I would allow him to exit this place with dignity and peacefully.

Just let this discussion remind everyone that we should be putting plans into place so that our children are not faced with same dilemma when it comes to our turn.
 

Jaded'n'faded

Registered User
Jan 23, 2019
1,374
0
High Peak
Consider also what your mum would have wanted, pre-dementia. I'm sure if you put it to most people and said, 'If you had advanced dementia and maybe a broken hip, and your heart stopped, would you want the medics to do CPR?' most would say emphatically, 'No! What on earth for?'

We all have to die sooner or later. Quality of life is important. I would hate to end my life with three years of not knowing who I was or where I was and being constantly confused, agitated and scared as my mother did. The idea of prolonging her suffering - had I been in those circumstances - is unthinkable.
 

Duggies-girl

Registered User
Sep 6, 2017
2,494
0
Much as I hated asking dads GP to write up a DNR for dad I know it was the right thing to do. Dad thought he was very well and fit when in reality he was a very frail and shrunken old man with dementia and terminal cancer, it would have been cruel to perform resuscitation on him.

Sometimes prolonging life is prolonging suffering and I can't think of a better way to go than having the heart just stop naturally.
 

Canadian Joanne

Volunteer Moderator
Apr 8, 2005
16,958
0
67
Toronto, Canada
When my mother first went in care, the home presented us with 4 levels of care regarding DNR and other life-extending treatments. Over the years, as my mother's illness progressed, we made changes, as we had to review it every year. This was actually made easier for us as when she was well, my mother had often declared she did not want to be kept alive by machines.

At the end, we had opted for no hospital, DNR or extreme measures. We wanted her to die surrounded by people who knew her. She had a very quiet and peaceful death.
 

Bha

Registered User
Jun 17, 2020
36
0
My husband had a cardiac arrest at home when he was 73 years old. He had been unwell for many years with his heart and was going through an asessment for Alzheimer's at the time though still undiagnosed.

At that moment, I never felt that I could stand by and let him die so I gave him CPR for almost 10 minutes before the paramedics arrived. It was a shocking experience for me but he never remembered anything about it. I broke his breast bone and knew I had because I heard it crack very loudly. He was very ill for many weeks and he never could understand why his chest hurt so much.

He split his head open when he hit the floor so there was blood everywhere and by the time they got him off to hospital, the kitchen looked like a battlefield.

He was fitted with a defibrillator so I won't be faced with that decision again. He is now 81 years old and though his physical health is failing, he has been a high functioning person with dementia until recently.

I do not regret for one moment my actions then but that was then and now is a different world and a different life. I believe that now I would allow him to exit this place with dignity and peacefully.

Just let this discussion remind everyone that we should be putting plans into place so that our children are not faced with same dilemma when it comes to our turn.