FEBRUARY 28, 1994 VOLUME 1, NUMBER 15
Most health-care professionals are aware of the dangers and limited benefits associated with cardiopulmonary resuscitation in the elderly. Most elderly patients, however, may not fully realize what the risks and benefits are.
A new study of the wishes of the elderly indicates that better patient education might dramatically change decisions about CPR. According to an article in the February 24, 1994, Arizona Daily Star, the study was conducted by Dr. Donald J. Murphy at the Presbyterian-St. Luke’s Medical Center in Denver. Murphy asked 371 patients at the Medical Center’s Senior Citizen’s Health Center about their wishes for use of CPR. Then he gave them information about the statistical likelihood of recovery and survival, and questioned them again about their wishes.
Initially, 41% of the elderly surveyed indicated that they would like to have CPR administered if their hearts stopped while they were being treated for an acute illness. After Murphy and his researchers explained that the chances of surviving were statistically between 10% and 17%, nearly half changed their minds; only 22% of the surveyed patients still wanted CPR.
Not too surprisingly (at least, not to those who regularly work in the field), only 11% initially indicated that they would want CPR if they were being treated for a chronic illness with a prognosis of less than a year of life remaining anyway. After researchers informed the patients that the statistical likelihood of surviving long enough to be discharged was now reduced to less than 5%, half of those respondents changed their minds and indicated that they no longer would wish to have CPR administered.
Dr. Murphy observed that “most seniors are good gamblers. It’s not the life-sustaining machinery that intimidates them. They just don’t want to be on it for any length of time if the prognosis is poor.” Indeed.
Dr. Murphy’s study has some obvious policy ramifications. If less than 5% of competent patients indicate they would want CPR if chronically ill and with little hope of recovery, why do we default in favor of CPR for all patients? Of course, we already know the importance of advance directives, but this study tremendously reinforces that need.
Recovery by Woman Frozen to Floor
As a counterpoint to the news about CPR and recovery rates, the same issue of The Arizona Daily Star included an article about the 91-year-old woman who was found frozen to the floor in her unheated home last month. Victoria Moryn had two toes amputated and will require physical therapy, but has recovered enough to return home. The story was silent about what, if any, improvements have been made in her home and living conditions during her absence.