Doctor questions the logic of reviving care home residents

Doctor questions the logic of reviving care home residents

Friday, 24 February 2006

IAN JOHNSTON
SCIENCE CORRESPONDENT

THE policy of automatically trying to resuscitate an elderly care home resident who has a heart attack should be reconsidered, as the chances of success are so low, according to a paper in the British Medical Journal.

Dr Simon Conroy, a clinical lecturer in geriatrics at Queen's Medical Centre in Nottingham, and colleagues said that the chances of reviving someone in this situation varied from between zero and 6 per cent, compared with 14 per cent in an acute hospital. Even then, the survivors often suffer a further deterioration in their health.

The authors of the paper said a cost-benefit analysis might show that resources would be better spent elsewhere. "If one person in a care home or hospital is to be provided with cardiopulmonary resuscitation, all staff require training and the appropriate resources need to be funded," the paper said.

"Given the likely low chance of success, it may be that the institution should not offer resuscitation at all. Resources saved by not spending time in training and the subsequent discussions could be better used in improving the quality of care.

"Potential clients or their representatives could be given a statement explaining the non-resuscitation policy of the institution. They would then be able to choose whether to accept or decline."

The paper said making the best use of available resources was an important part of ensuring justice in healthcare. "Dramatic, life-saving interventions have often been thought of as having first call on resources, but there is no reason why their costs and benefits should not be appraised like those of other treatments," the authors said.

"If the chances of success were low (perhaps less than 2 per cent or 5 per cent), a 'do not resuscitate' order could be issued without further discussion, unless the patient or resident requested it.

"In this case, the discussion would largely be an explanation of 'why not', rather than a negotiation about 'whether'."

The paper said a typical nursing home might look after about 70 people and expect 46 deaths a year.

"Even assuming that cardiopulmonary resuscitation is provided to six residents a year, with a survival to discharge rate of 2 per cent, only one person might survive every eight years," it said.

"The survivor would have a 30 per cent chance of useful recovery, probably from an already poor state of health. Staff would spend large amounts of time explaining resuscitation to each new resident and be diverted from generally under-resourced core care activities."