July 24th, 2013 at 10:00 am
Bookmark and Share

Caregivers need to know elders’ wishes about prolonging life

by Dorian Martin

Lately, the question of quality of life vs. quantity of life for elders has been on my mind.

That question initially arose because of the ongoing coverage of Nelson Mandela’s health concerns. There have been conflicting reports about his status. Mandela, who has been hospitalized for a while, was described as being in a permanent vegetative state in a court filing while other reports indicated that he was responsive, but placed on life support to assist with breathing. (USA Today reported that as of his 95th birthday, Mandela is steadily improving.) A South African newspaper suggested that the country’s former president doesn’t have a living will, which could be problematic when end-of-life decisions need to be made since his family seems to not be a united group.

The second reason I have been contemplating this question is my dad, who recently spent a week in the hospital. One of Dad’s friends visited him there and was upset to see Dad wearing a wristband stating DNR – Do Not Resuscitate. Fortunately, that message never had to be invoked. However, it did make me think through various scenarios.

Making Wishes Known

I am fortunate because I have heard Dad express his wishes to his primary care physician. Therefore, I know what he wants, which is important because I am listed on Dad’s durable power of attorney for health care as the person to make decisions if Dad becomes unable to make his own health care decisions. Furthermore, I have a copy of Dad’s signed directive to physicians/living will that states he does not want to have his life artificially prolonged through resuscitation in the event of cardiac arrest, being placed on life support or using nasogastric tubes, gastrostomy tubes, respiratory assistive devices, or intravenous hydration or electrolyte replacement.

Quality of Life

I discussed Dad’s decision this weekend with a friend who is taking care of an elder. I pointed out that some of these procedures are not necessarily effective. Dr. Robert H. Shmerling, an associate physician at Beth Israel Deaconess Medical Center, wrote on the Aetna website about problems with CPR. He noted that CPR (without the use of automatic defibrillators) is successful in less than 5 percent of the cases of elderly people who have multiple medical problems and in 6-15 percent of hospitalized patients. (He does add that certain new techniques for CPR might improve success rates.)

“Research shows that older people who are frail, with functional limitations like difficulty walking or getting up from a chair, are less likely to survive CPR,” stated New York Times reporter Judith Graham in the paper’s New Old Age column. And such procedures can actually lower an elder’s quality of life. Graham reported that CPR can cause broken ribs, fractured sternums, punctured lungs, punctured liver, vomit in the lungs and significant pain.

These are additional reasons why it’s important for caregivers to know what an elder wants — and confirm that the legal documentation to make sure these wishes are followed is complete and readily accessible. I discussed some similar ideas in another blog post about respecting elder’s wishes to die at home.

Posted in Caregiving, Death | No Comments »
Tags: ,

Leave a Reply