Resuscitation of demented people

Physicians' attitudes towards 'do-not-resuscitate' orders for the elderly: a survey in Saudi Arabia

To study physicians' attitudes towards do-not-resuscitate orders (DNR) in the elderly and analyze the responses to some of the factors that may influence the resuscitation decisions, a self-completed questionnaire was administered to physicians in the departments of Medicine and Critical Care in three cities in Saudi Arabia. Physicians were asked whether they would recommend DNR for two hypothetical cases, one elderly and previously functional and another younger patient suffering from severe dementia. They were asked also to grade the importance of a number of factors that may have some influence on the resuscitation decisions. A total of 249 physicians participated in the study (a response rate of 79%). Only 16% of physicians indicated they would recommend DNR for the previously healthy elderly as opposed to 61% for the patient with dementia (P<0.001). When considering DNR orders, physicians ranked dignity of the patient, religious and legal concerns highly, and cared least about expenses of the medical care. In conclusion, most physicians assigned more importance to the functional status of the patient than the biological age. When considering DNR, physicians in Saudi Arabia shared with their counterparts in the West many features, notably caring about dignity of the patient, but were also concerned about the religious and the legal stand. This may be related to the absence of clear local policies and guidelines.

End of life treatment decisions in people with dementia: carers' views and the factors which influence them

OBJECTIVE

Treatment decisions in life threatening situations (TD) are poorly studied in people with dementia.

METHOD

The carers of people with dementia were asked four TD questions, pertaining to cardiac resuscitation, intravenous fluids, oral antibiotics and intravenous antibiotics. The impact of key variables (age, dementia severity, psychiatric co-morbidity, physical illness, family relationship of carer) on TD were evaluated.

RESULTS

Fifty carers participated, 46% wanted cardiac resuscitation, 60% wanted treatment with intravenous fluids, 52% wanted treatment with intravenous antibiotics and 60% wanted treatment with oral antibiotics. Agreement between questions was high (76 - 89%), suggesting that relatives were either for or against intervention. There was an association between more severe dementia and a reduced wish for intravenous antibiotics. None of the variables significantly influenced other TD.

CONCLUSION

The 'global' view of carers, was not influenced greatly by key disease variables. There are potential implications for the way in which carers are used as proxy decision makers.