Understanding Code Status in Geriatrics
Typical situations could be a patient coming from a nursing home to the hospital for IV hydration from the flu, fever of unknown origin, confusion related to a urinary tract infection, shortness of breath, chest pain, and yes, the occasional constipation.
Sometimes nurses question why a geriatric patient with a do not resuscitate order was being admitted for treatment. The answer is very simple. They need treatment for a preventable illness regardless of age or living situation.
The patient may be elderly and living in a nursing home or assisted living facility. They may or may not be thriving in their environment. However, they have friends and family that love and care for them dearly. The patient also has the right to receive treatment based on the diagnosis, regardless of age or living will status.
A do not resuscitate order is used in the event of cardiac or respiratory arrest and terminal illnesses. It is used to prevent invasive and unnecessary treatment at end of life. Most patients have discussed with their physicians, family, or health care proxy the circumstances surrounding the use of the do not resuscitate order.
Treatment of many diseases can prolong life and enhance quality of life with positive outcomes. For example the use of antibiotics, surgery, temporary mechanical ventilation, hydration, blood transfusion, respiratory treatments, and yes the occasional soap suds enema.
What is troubling is the issue between the two orders can at times become confused more with the geriatric population. Yes the elderly are frail, may or may not have the quality of life they wished for, or have the family to care for them at home.
However, they do have family and friends that love them dearly. They in fact have made friends within their new community and with other residents and health care providers who care very deeply about them.
The patient may actually be thriving in their environment and look forward to the next activity, group outing, holiday, or family visit from children, grandchildren, great grandchildren, and possibly the smile and cooing from the first great great grandchild.
It is not up to us to decide at what age or circumstance treatment should begin or end. That is a personal decision between the patient, family, and physician. As is the decision for when to stop resuscitation measures.
Our role is to provide comfort, compassion, dignity, and respect to all patients across the age spectrum, and to honor their wishes for appropriate treatment.
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