Monday, March 18, 2013

For our seniors and frail elderly, what to ask your doctor, procedures to avoid

I've been doing some reading about this issue: when is a treatment best left undone.
When is a DNR order a good idea?
Do you question the drugs routinely prescribed? What about tests that will not help the patient, and may tire them needlessly whilst feebly shlepping to hospitals.
This is an important read:
It is important to question the doctor.
Ask about treatment side effects, treatment options; ask about the patient's disease trajectory.
When is it time to declare a patient palliative, and not just for health insurance reasons?

For the Elderly, Medical Procedures to Avoid By PAULA SPAN

What should you avoid?

1. Feeding tubes  - Read more here.
2. Antipsychotics - The geriatricians’ list warns against prescribing of antipsychotic medications for dementia patients who become aggressive or disruptive. These drugs: Haldol, Risperdal and Zyprexa, have been shown to increase the risk of stroke and cardiovascular death.
3. Contraindicated and commonly overused medical tests, procedures and treatments.
4. CPR - vs. DNR - see below
5. Implantable cardioverter-defibrillators - they can be turned off
6. Sleeping pills as the first choice for older people who suffer from agitation, delirium or insomnia. Xanax, Ativan, Valium, Ambien, Lunesta. Dome increase agitation, lessen the ability of someone to sleep at night, causing falls. 

New Data to Consider in D.N.R. Decisions

What has not been clear is what happened to older hospital patients who left the hospital after a cardiac arrest and CPR. A new study in The New England Journal of Medicine...
  • Study Group Population of 6,972 elderly people who survived in-hospital cardiac arrests between 2000 and 2008
  • One year after exiting the hospital, 58.5% of these older patients were still alive. 
  • Of this group, 48% had little or no neurological impairment
  • 52% had moderate or severe neurological damage. 
  • Only 40% returned to life at home
  • And 60% went to nursing homes, rehabilitation facilities or hospices. 
  • Of those 85-years-old+, almost 50% survived one year.
  • About 66% of older patients ended up readmitted to a hospital within one year — an indication of some level of continuing medical difficulties.
When We Die, and Doctors 'Did Everything They Could,' Should Our Families Watch?
When someone's heart stops beating in a hospital, doctors, nurses, and technologists run to their room. One will stand over the patient on a tall stool to get a vantage where they use the leverage of their entire upper body to compress the patient's chest. It's not uncommon to hear and feel ribs cracking under their fingers as they press. Keeping the person's airway open can mean passing a large tube down their throat. Shocks of electricity are delivered that can make their limp body convulse. Doctors often need to insert a large I.V. through the side of the patient's neck in order to give the drugs that help restart their heart, which can be a bloody procedure.
Of 570 people, the 211 who witnessed resuscitation of a family member later reported significantly fewer symptoms of PTSD -- and less anxiety and depression -- at checkups following the event, regardless of whether the person survived.

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