A follow-up of 6,972 people aged 64 years and older who had undergone a cardio respiratory arrest whilst they were hospitalised in an inpatient facility showed that the survival rate, after one year from the attack, was barely 10%, and if this estimate was restricted to people with no neurological injuries, the rate was halved. We don’t have data on the mid and long-term results for older people who are resuscitated outside of the hospital, but it all seems to be worse.
Aware of the bad omens of the heart failures at an advanced age, John Ballard, a retiree born and raised in the southern US, and an old fashioned liberal, as he defines himself, answered a tweet of mine on his blog in this manner:
Cardiopulmonar Resuscitation in elder: the mirage of numbers https://t.co/bwGhtULUV6 pic.twitter.com/lpiG5egsOd— Jordi Varela (@gesclinvarela) 17 de enero de 2017
— John Ballard (@Hootsbudy) 19 de enero de 2017
Curious, I clicked the link and found the following transcript of a "Do not Resuscitate me" statement.
"To Dr. H---- or whom it may concern:
I want a DNR bracelet and/or tag to wear around my neck indicating that in the unlikely event my heart and breathing stop no CPR or intubation will be used to resuscitate me. I realize this is an unusual request and that despite clear instructions to the contrary EMR teams or others trained in CPR, motivated by the best of good intentions, may intervene anyway.
A copy of my advance directive for medical care is in your file, but it’s not practical to carry on my person all the time. A bracelet or tag with my ID and telephone (or other validating contact) is more suitable.
To be clear, I do not want to die. But that is not the same as saying I am not ready to die. As many military and first responders know, being ready to die and wanting to die are not the same and must not be confused.
My reasons for carrying a DNR are easy to explain. At this writing (age 71) I have spent the last twelve years working as a caregiver, mainly with seniors. During five years in a retirement community and seven years as a non-medical caregiver via an agency I have had many assignments and have seen the effects of age and disability in a way that most people never do. When I die I want to be remembered as someone leading a full life, productive and helpful to others. As I now approach the end of the actuarial tables, the longer I live the less likely that outcome will be.
I have seen too many people dying a little at a time, increasingly dependent on others even for the simplest needs. The decline may be physical, cognitive or both. But in all cases the quality of life is compromised a little at a time until the dying person is left in a miserable condition, often for years, waiting, waiting for that final appointment with the Angel of Death. That is a condition I want to prevent, if possible, by deciding now against heroic life-extending measures."
Editor
Thanks for this. I'm a firm believer that both end of life and beginning of life issues are not only the most important of all human decisions but also deeply personal. I hope my reflections will be helpful to others as you pass them along.
ReplyDeleteThanks to you for your ideas and your statement. It's very helpful to other people.
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