Educating the elderly about CPR decisions - Tips From Other Journals

Date: August, 1991

Recent studies indicate that cardiopulmonary resuscitation (CPR) for cardiopulmonary arrest has limited success in achieving survival to hospital discharge in patients over 70 years of age, especially among patients with multiple disease processes. At the time that a patient is acutely ill, a discussion concerning whether CPR should be performed is often awkward; the patient may not be able to make an informed decision. It is more appropriate to educate, discuss and determine preferences for CPR with healthy adult patients during routine office visits. Schonwetter and colleagues conducted a study to evaluate an elderly population's attitudes and knowledge about CPR before and after patient education.

Sixty-four ambulatory patients who attended a veterans outpatient clinic during a three-month period were interviewed and educated about CPR. The patients were all over 74 years of age (mean age: 82 years). A questionnaire that documented demographic data was administered to the patients. The interviewer also tested the patients knowledge about what is involved when CPR is administered for cardiopulmonary arrest. All of the patients were then given a standard description of a sudden cardiopulmonary arrest and subsequent CPR, with its possible risks and benefits.

Most of the patients thought that the use of CPR should be routinely discussed with a physician. Only 17 percent had discussed decisions about CPR with their family, and none had done so with physicians. Knowledge about what was involved with CPR was variable; most patients overestimated their chances of survival with CPR. In considering five hypothetical scenarios, 9 percent of the patients said that they would not have wanted CPR and 17 percent stated that they would have wanted CPR in each instance. Although knowledge significantly increased after CPR education intervention, the patients' preferences regarding CPR did not change significantly.

The study findings indicate that most older patients wish to discuss their opinions about CPR with their physicians. In addition, most elderly patients have fixed preferences that may be easily discussed while their clinical condition is stable. journal of the American Geriatrics Society, April 1991, vol. 39, p. 372.)

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