Older people ‘feeling pressured’ into signing Do Not Attempt CPR forms, care coalition warn
Older people are feeling pressured into signing “Do Not Attempt CPR” forms, a coalition of charities said.
Organisations supporting the elderly said they were hearing “shocking examples” of blanket decisions seemingly being made about the care and treatment of older people.
Many of those who have been affected said they felt as if “their lives and wishes do not matter”, they said in a joint statement.
One 85-year-old woman was called by her GP, who asked if she wanted to go to hospital if she developed coronavirus or if she would sign a do not attempt CPR form.
The woman, who has several long-term health problems but still enjoys life, “felt mortified and was extremely upset when she received a letter with a form in a few days later”, Age UK said.
An 80-year-old man with mobility problems was also contacted unexpectedly by his GP about whether he wanted hospital treatment, and found the call “confusing and muddling and did not understand”.
The charities said the examples were “shameful and unacceptable”.
The nine signatories include Caroline Abrahams, director of Age UK, Deborah Alsina, chief executive of Independent Age, Donald Macaskill, chief executive of Scottish Care, and the Commissioners for Older People in Wales and Northern Ireland.
They said: “Difficult and painful decisions will need to be made in the weeks ahead, but these must be made on a case-by-case basis, taking account of the risks and benefits, and people’s own wishes, through honest discussions between patients, doctors and families.
“Whether or not to sign a ‘do not attempt CPR’ form is an individual’s decision, and they have a right to make that decision without feeling pressurised.
“We do not underestimate the significant pressures being faced by all staff working across our health and social care sectors at this difficult time, but it is crucial that we continue to protect people’s fundamental human rights.
“It would be completely unacceptable to abandon these rights in favour of taking blanket, discriminatory decisions.”
They are calling for stronger leadership across the UK to avoid “further worry and upset” during the coming months.
It comes as a group of organisations representing people with dementia warned of a “risk of age and health status indirectly becoming standard criteria for triage”.
Alzheimer Europe, which represents 22 national organisations from 19 European countries, is calling on governments to ensure any access or withdrawal regulations to life-saving treatment do not discriminate against people with dementia.
Triage decisions should be based on a patient’s individual prognosis and not solely on their age, diagnosis or place of residence, it said.
Helen Rochford-Brennan (pictured), chairwoman of the European working group of people with dementia, said: “Many people are able to live long and meaningful lives with dementia with a good quality of life.
“A diagnosis of dementia should never be a reason to be refused treatment, care or support.”
Last week the The Alzheimer’s Society said it has been hearing from people with dementia who are “absolutely terrified” of going to hospital, where they are unsure they will receive the right treatment.
Guidelines released by the National Institute for Health and Care Excellence (Nice) state that healthcare professionals should assess patients with Covid-19 on the basis of “frailty”, before discussions around the provision of critical care.
The Alzheimer’s Society has asked for a review of the guidelines, and for them to make clear that “cognitive frailty is not discriminated against when having to make life or death decisions”.
A Nice spokesman said: “We agree that whether or not to sign a DNA-CPR form is an individual’s decision, and they have a right to make that decision without feeling pressurised.
“Our Covid-19 rapid guideline on symptom management in the community is very clear in saying that, when possible, the risks, benefits and possible likely outcomes of the treatment options should be discussed with patients, and their families and carers, so that they can express their own preferences about their treatment and escalation plans.
“For patients with pre-existing advanced comorbidities, it also says that if people have existing advance care plans or advance decisions to refuse treatment, including do not attempt resuscitation decisions, this should be documented clearly and taken into account when planning care.”
The spokesman said Nice is continually reviewing its guidelines on critical care in line with new evidence and as practice evolves.”
He added: “Nice has always made clear that clinicians should take any decisions about care in conjunction with patients and their carers where possible, and it is particularly important that a holistic assessment is carried out in people with dementia.”
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