Increasing use of DNR orders in the elderly worldwide
in all individuals, including the elderly, over the past several decades.1 11 Several surveys suggest that the majority of hospitalised and institutionalised patients in the United States, and many abroad,
die with a DNR order in place,7 which was not true twenty years ago. The US Patient Self Determination Act of 1991, which requires patients be informed of
their rights to issue advance directives and be involved in medical decision making, appears to have increased the use of
DNR orders.12 While the use of the DNR order has been less systematically studied in other countries, many patients in the developed and
developing world also die with a DNR order in place .12 21
The eldepatagonia men's down sweater for salerly are more likely than the young to be the recidiscount patagonia down jacketspients of DNR orders. Most,6,10,13 15,22 29 but not all1 surveys indicate older patients, regardless of prpatagonia women's better fleece jacketognosis, are more frequently given a DNR order tpatagonia alpine guide pants reihan a young patients. It
remains an open question, hopatagonia women's better fleece jacket0wever, whether more elderly people die with a DNR order in place because they are actually choosing
to do so. Many studies show that most patients are never asked by a doctor if they wish to be resuscitated, despite a desire
to express their wishes. Data from the SUPPORT (Study tpatagonia women's better fleece jacket1o Understand Prognoses and Preferences for Outcomes and Risks of Treatment)
project, canvassing almost 1000 seriously ill elderly patients, noted that only approximately one quarter had ever discussed
CPR with a physician.30 A survey of approximately 400 nursing home patients showed that roughly a similar number of them hadpatagonia outlet store ecko ever been asked about
CPR by a doctor.31
Usually, the decision to withhold resuscitation is made by family members rather than the patients themselves2,6,17,32,33 together with phpatagonia argentina beautiful place to liveysicians, often initially medical residents, if the patient is an inpatient.34 This mapatagonia discount code ballardy be in large part a result of failure to consider the use of DNR orders until patients are no longer capable of participating
in the decision.2,32
In an editorial in 2000 in the British Medical Journal, Ebrahim cited thpatagonia discount code 23e failure of physicians to elicit the participation of patients and even family members in the depatagonia everlong review for nursescision to
write a DNR order for elderly patients as evidence of possible bias on the part of doctors against the elderly ( ageism ).35 In this article, published evidence of patient and physician knowledge and attitudes toward DNR decision making will be reviewed.
STUDIES OF PATIENT AND FAMILY ATTITUDES TOWARD DNR ORDERS
Several US studies involving several hundred elderly outpatients have suggested patients want to discuss CPR with their doctors.36patagonia guide jacket trends 38 Often, patients want their physician to bring up the subject,38,39 preferably while they are still healthy.40 Most patients interviewed had not talked about CPR with their practitioners.38,39,41 52 If they had spoken with their doctors, they frequently had little patagonia women's better fleece jacket2undepatagonia women's better fleece jacket3rstanding of exactly what CPR entailed before thatIn the United States, the majority of investigated patients have CPR preferences and want to be part of the decision making
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