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Esther Heerema, MSW

End-of-Life Decisions for Loved Ones with Alzheimer's Disease

By November 11, 2012

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As a social worker, I've had the privilege to speak with many people with dementia as well as their families about end-of-life care. Some people have everything planned and written out, and have distributed copies of their directives to their physician, attorney and family members.  Others have not even considered what they want the medical community to do if their health significantly declines. This may be because it's uncomfortable and hard to think about, they're already overwhelmed with daily decisions, or they're not even aware of the different choices they have.

One of the decisions people face when they're admitted into a hospital or a health facility such as a nursing home is whether or not to receive CPR if their heart stops beating or they stop breathing. CPR (cardiopulmonary resuscitation) can be a life-saving technique and is the default position of medical personnel. In other words, everything will be done to keep someone alive unless there is a directive otherwise. Those who opt to forgo CPR may choose a DNR (do not resuscitate) order.

For someone who's younger and healthy, and then suddenly goes into cardiac arrest, CPR can sometimes restart their heart and eventually may lead to a full recovery.  For others, however, such as people who have a chronic condition, are medically frail or elderly, CPR is frequently ineffective. It can also lead to invasive procedures such as intubation and being hooked up to a ventilator with little hope of being successfully removed. The statistics are stark when it comes to describing the chance of survival for people in these circumstances.

During the decision-making process, I've heard the question, "Am I giving up on my loved one if I don't choose CPR? " In response, I've often reassured people that choosing a DNR order is vastly different than giving up on their family member; it simply may allow for a more peaceful death. I also always want them to know that whatever they choose, we will do everything we can to honor their wishes.

More Information on End of Life Decisions

Alzheimer's and End-of-Life Care: Do Not Resuscitate or Full Code?

What Are Living Wills and How Can They Benefit People with Alzheimer's Disease?

Have you been in the situation where you've chosen CPR or a DNR order for a loved one with dementia? If so, what was was helpful to you in your decision?

Comments
November 12, 2012 at 2:21 pm
(1) Don Franklin says:

My name is Don Franklin and you may remember my article titled “Rita, Alzheimer’s and Me”, sitll available in the Caregivers section.

Anyway, I was faced with the decision of CPR or DNR when Rita was in her final phase. Even though it was a very difficult decision to make, Rita had made it easier for me because we both had Living Wills. I had no choice but to follow her wishes and choose DNR. Looking back on it now, I know that was the best choice. It was bad enough to see her suffer with the disease, but it would have been worse to see her have a stroke or something, not recover completely, and maybe live the rest of her life as a vegetable. None of that happened however, but it certainly could have. It is also best to make sure they are under hospice care during those final days

November 13, 2012 at 9:36 pm
(2) Karen says:

While a DNR option was decided for my mom while she was at a day program it was not followed. I was called and asked what we wanted, CPR or DNR, minutes before she died of a massive heart attack. During this stressful call I said CPR and then realized it should be DNR – what was suppose to be on her file at the day program. This may not be referenced in an emergency situation and an emergency contact may not instantly think of what is best for their loved one under duress.

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