Letters
Volume 197 - Issue 2

Should resuscitation replace good communication in the care of elderly patients?

Authors:  Campbell H Thompson and Margaret Brown

Med J Aust 2012; 197 (2): 89. || doi: 10.5694/mja12.10401
Published online: 16 July 2012
To the Editor: There are challenging ethical, legal and clinical issues associated with resuscitation and end-of-life care for older people. When an elderly patient with comorbidities and limited independence deteriorates, and is unable to participate in decision making, is it good medical practice to subject that person to invasive and traumatic resuscitation when the survival rate is less than 3.4%?1 Currently, many older patients will be ...
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To the Editor: There are challenging ethical, legal and clinical issues associated with resuscitation and end-of-life care for older people. When an elderly patient with comorbidities and limited independence deteriorates, and is unable to participate in decision making, is it good medical practice to subject that person to invasive and traumatic resuscitation when the survival rate is less than 3.4%?1

Currently, many older patients will be subjected to resuscitation if a do-not-resuscitate order is not documented; yet clear, contemporary documentation is an important part of good medical practice.2

In Australia, there is no consistent approach to the documentation or communication of resuscitation decisions.3 In most hospitals, resuscitation will be commenced if there is a rapid decline in the patient’s health, unless there are clearly documented orders not to resuscitate. Yet, fewer than 45% of hospital inpatients have any resuscitation documentation in their case notes.4 Between 8% and 16% of people living in a residential care facility or aged over 70 years have “for full resuscitation” documented.5,6 A recent audit at a major teaching hospital in Adelaide found that its resuscitation documentation was often difficult to read or interpret, with no consistent use of language or terms (unpublished data). This indicates a lack of communication between clinicians and their older patients about resuscitation decisions, which must affect the care of people at the end of their life.

We are raising concerns about the current default policy of resuscitating older patients with comorbidities when there is no available documentation. We recommend earlier discussions with patients, their families and doctors about advance care planning, which are then clearly documented in admission notes.

As so few elderly patients request full resuscitation, we call for a public debate on the current default resuscitation policy, in order to better inform medical practice. We suggest physicians could do more to protect their older patients from harm by adopting a palliative care approach so the person can die with respect and dignity.

Authors

  • Campbell H Thompson1
  • Margaret Brown2
  • 1. University of Adelaide, Adelaide, SA.
  • 2. Hawke Research Institute, University of South Australia, Adelaide, SA.

Correspondence: Campbell.thompson@adelaide.edu.au

Competing interests

No relevant disclosures.

References

View this article on Wiley Online Library