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CMAJ • October 14, 2003; 169 (8)
© 2003 Canadian Medical Association or its licensors

Review
Synthèse

Determining resuscitation preferences of elderly inpatients: a review of the literature

Christopher Frank, Daren K. Heyland, Benjamin Chen, Donald Farquhar, Kathryn Myers and Ken Iwaasa

From the Departments of Medicine (Frank, Heyland, Chen, Farquhar, Myers) and Community Health and Epidemiology (Heyland), Queen's University, Kingston, Ont., and the Department of Family Medicine, University of Toronto, Toronto, Ont. (Iwaasa)

Correspondence to: Dr. Christopher Frank, St. Mary's of the Lake Hospital, 340 Union St., Kingston ON K7L 5A2; fax 613 544-4017; frankc{at}pccchealth.org

Abstract

STUDIES HAVE SHOWN THAT DISCUSSIONS with elderly hospital patients about cardiopulmonary resuscitation (CPR) preferences occur infrequently and have variable content. Our objective was to identify themes in the existing literature that could be used to increase the frequency and improve the quality of such discussions. We found that patients and families are familiar with the concept of CPR but have limited understanding of the procedure and overestimate its benefit. Most patients are interested in being involved in discussions about CPR and in sharing responsibility for decisions with physicians; however, older patients who participate in these discussions may have variable decision-making capacity. Physicians do not routinely discuss CPR with older patients, and patients do not initiate such discussions. When discussions do occur, the information provided to patients or families about resuscitation and its outcomes is not always consistent. Physicians should initiate CPR discussions, consider patients' levels of understanding and decision-making capacity, share responsibility for decisions where appropriate and involve the family where possible. Documentation of discussions and patient preferences may help to minimize misunderstandings and increase the stability of the decision during subsequent admissions to hospital.




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