If You’re Over 70, Why Your Doctor Should Order DNR/AND on Admission to Hospital or LTC

For anyone admitted to hospital or into LTC, when their heart stops they will automatically receive CPR (CardioPulmonary Resuscitation) unless there is an order to Allow Natural Death (AND) or DNR.  For this age group, especially if they have a life-limiting disease (ESRD, ESLD, CHF, most metastatic cancers, AIDS, ALS, Alzheimers liver failure), an AND/DNR order is appropriate for the following reasons:

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The Downward Spiral: Predicting Survival For People Over The Age Of 70 And Who Are Admitted To Hospital

Everyone wants to live as long as possible but also as comfortable as possible – clean, dry, pain-free, and well fed.  Years ago most people died fairly quickly:  they were active until they developed pneumonia or some overwhelming infection from an injury.  Now, our drugs and technology can keep people alive for months or years but not necessarily without pain – chronic diseases can produce a “slow death”.

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Making Choices – Choosing Comfort (Palliative Care) When There is no Cure

As we get older, it is natural to expect at least a few health problems.  Aches and pains seem to go hand in hand with getting older and that we will have to endure more age-related symptoms. Several studies show that older people’s fears are related to unrelieved pain and/or to loneliness following the death of a spouse or friends.

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Expectations in LTC (Long Term Care): What’s Realistic?

Expectations and goals of care

Our expectations – residents’, families’, and staff’s – should be based on the following two realities:  for almost all of our residents, this will be their final home; and, most elders, in our experience, are concerned more with function and comfort than just living years. Therefore, we have an obligation to keep our residents clean, dry, and both physically and emotionally comfortable, while encouraging as much independence as appropriate  – in other words, to provide TLC (Tender Loving Care).

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