DNR(1)

lqadams

My husband has Lewy Body dementia,  probably stage 6, 76 years old.  Getting increasingly weaker and needs wheeled walker, almost no short term memory , cannot follow movie/TV, incontinent (including occasional bowel).  Still eats well and can feed himself.

I am considering ending all doctor visits except for neurologist.  Have any of you done so? And, what is involved in getting a DNR? He has very little quality of life, but does that qualify for a DNR? 

I just don't believe that extreme measures should be taken to save him if he should have a stroke, heart attack, etc.

This is a heart wrenching decision and I would appreciate input. 

June45

My husband is on the cusp of stage 7, Alzheimer's, same age as yours and the same lack of abilities. I plan to do a DNR on the next doctor visit. I am my husband's health surrogate...this legal document was done at the beginning of his illness.  Some states have a standardized DNR; your doctor should what is needed. I was told that I can choose to override it if I change my mind.

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jfkoc

"A do-not-resuscitate order, or DNR order, is a medical order written by a doctor. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient's heart stops beating."

Doityourselfer

In New York State, we have a Medical Orders for Life-Sustaining Treatment (MOLST) for my husband.  It includes DNR, DNI (do not intubate) and no feeding tube.

Quilting brings calm

My parents and their family doctor discuss a DNR every year at their Medicare wellness visit.  It can be done at any time, and then electronically placed in their file at the doctors office and at their area hospital.  They don’t have to be ill at all to file one.  As his medical POA you could possibly  file one if he’s been declared incompetent.   Since you would be the one making decisions if  he needed medical treatment. 

lqadams

Thank you for the replies. I do have DPOA as well as Medical POA. I will discuss the DNR with neurologist when we see him in Oct. Sooner if necessary. Such a difficult decision to let someone go.

jfkoc

A DNR does not mean you "let someone go". It is very specific.

Cynbar

As mentioned above, ask the doctor about completing a MOLST. That includes the DNR order plus other important decisions --- do not intubate, do not hospitalize, dialysis or not if needed, IV hydration or not, feeding tube or not. You say yes or no to each item, they don't all have to be no. But it gives more info to the doctor and to your family. Plus, although it isn't the intent, these orders are not irrevocable. You can change your mind if the situation warrants. It has to be signed by the patient (or his representative) and the doctor to go into effect.

lqadams

Thank you for telling me  those important details.

Stuck in the middle

Don't forget "No CPR."  I discussed this with a specialist in geriatric medicine who treated my mother briefly when she was about 95 years old.  He suggested she not return to see him, but rely on the doctor who visited the NH each week, and no hospital visits regardless.  He also suggested no CPR.  As the doctor described it, CPR includes beating on her chest with fists as hard as they can, breaking her ribs.  I agreed with him that I did not want my mother treated that way.

M1

Two additional thoughts:  you may be able to accomplish the same things by 1) calling yourself for a Hospice evaluation; this does not require a doctor's order; and 2) download a living will form off the internet.  He won't be able to sign it, but you can as his healthcare POA.   You can also opt for palliative care yourself by simply not taking him to any emergency room for evaluation in case of a downturn.  That's where Hospice can help you manage things at home for comfort care.

sandwichone123

I went to the sit at fivewishes.org about three years ago and got the family pack. Had the end-of-life discussion with everyone is the family from 80's to the 25-year-olds. Even if we didn't fill out all the forms, we had the discussion. I have filled out mine and documented my wishes for who should be my medical POA, what treatments I do and don't want, etc. I recommend the site 1000%!

Diane

mommom9

Hi My husband was recently in hospital. While there the nurses discussed POLST with me. It is a legal DNR/DNI that you always carry with you. It is and end of life firmportsbke firm that has been honored in USA since I believe 2012. It helps to know I don’t have to have that dnr discussion anymore. My husband is now on hospice which varies state to state have a good relationship with your primary doctor. Keep hospice in conversation along the journey. My dr actually started the conversation a very caring doctor. I love my husband very much however he mows feels like my very large child. Keep strong fellow caregivers this journey us hard and bittersweet. I forgot it was out anniversary yesterday. I remembered leading up to it but the day came and went   Definitely makes me realized how much has changed. God bless us all

lqadams

Thank you. I will ask Neurologist about POLST

Crushed

We are just updating DW's MOLST from. Most forms of care are excluded.  We did permit "airplane care"  CPR and/ or Oxygen.  I had two reasons . DW had been the onboard doctor several times and that was all she had to work with.  I felt she had earned it. plus if she falls over I didn't  want any staff person to get "blamed" for starting CPR.

JDancer

In Indiana, we a have a POST form. It specifies exactly what treatments you want. Once it's signed, it is the patient's default, but can be changed. 

DNR does not mean do not provide care. It only dictates what is done if respirations and heart function cease. 

Chest compressions, if done correctly, will break ribs in most patients.

It is not unreasonable to limit health care and "life saving" interventions as we age,  with or without dementia. A longer life is not always a better life. All of us should plan for end of life care, and make our wishes known.

lqadams

Thank you  for all the comments and recommendations. I have researched a bit and discovered that, unfortunately,  Arizona does not have a POLST Program. Three recommended things to have are a Living Will, POA and DNR. We already have Living Will and POA. So, will speak to neurologist and see about getting the DNR.

Melodious bird

We do a POLST in Maine, I think it is the same thing. My husbands geriatrician suggested we fill one out while my husband was still able to make decisions.

JDancer

Read the living will carefully. Many use terms like, "if I am unlikely to survive," etc. Many are so vague, they seem practically worthless. In many states, a doctor is not needed to fill out DNR paperwork, it simply needs to be witnessed. But if you have questions, it's helpful to discuss it with a doctor

Crushed

lqadams wrote:

Thank you  for all the comments and recommendations. I have researched a bit and discovered that, unfortunately,  Arizona does not have a POLST Program. Three recommended things to have are a Living Will, POA and DNR. We already have Living Will and POA. So, will speak to neurologist and see about getting the DNR.

that information is out of date
Look up AZMOST
  

March 8, 2017

Arizona

Arizona EMS Supports AzMOST

End-of-life care is improving in Arizona, thanks to the hard work and dedication of EMS representatives who led the recent adoption of a new protocol by the Arizona Department of Health Services Emergency Medical Services Council. The Council newly revised its Do Not Resuscitate Status/Advance Directives/Healthcare Power of Attorney Status: Adult & Pediatric protocol to include honoring MOST, MOLST, or POLST directives. EMS representatives spent months working with an end-of-life task force, reviewing national models and collecting evidence-based practices. The protocol adoption is a first for Arizona and demonstrates tremendous progress in the state’s approach to end-of-life care.

 

POLST

The POLST form helps seriously ill or frail patients get the medical treatments they want and avoid medical treatments they do not want. POLST forms are completed by a patient’s healthcare provider (physician, PA or NP) after discussing what is important to them, their diagnosis, what is likely to happen in the future and what their treatment options are. While an advance directive is for anyone that is 18 or older for future care a POLST form is only for those who are seriously ill or frail for current care. 

The POLST form is a portable medical order that follows the patient and helps healthcare providers understand the goals of care whenever or wherever the patient has a medical emergency and can’t speak for him or herself. Meant for individuals with a serious illness or frailty whose healthcare providers would not be surprised if they died within a year or so, the POLST form must be signed by both the patient and healthcare provider.

  

https://d3n8a8pro7vhmx.cloudfront.net/azhha/pages/317/attachments/original/1598844273/National_POLST_Form-AZ_11-19-19.pdf