Dutch discuss resuscitation for the elderly (News Feature)

By Rachel Levy Aug 23, 2008, 7:02 GMT

Amsterdam - Should people over 70 always be resuscitated? No, the St Pieters en Bloklands home for the elderly in the Dutch city of Amerfoort said this week.

If the home has its way, only residents who explicitly request it on special forms will be resuscitated following cardiac arrest.

But just days after announcing its new resuscitation policy, public outcry moved the home to put the implementation of its new policy on hold.

The home said it would wait for the results of a study by the Dutch Health Care Inspection (IGZ) about the consequences of resuscitation among elderly people. The study was requested by the leading coalition party, the Christian Democrats (CDA).

On Friday the IGZ said in a press statement that homes for the elderly should not implement a non-resuscitation policy.

The IGZ said the Amerfoort home had acted properly in evaluating its resuscitation policy, but had not provided accurate information to its residents about the consequences of resuscitation.

The debate about resuscitation among elderly people is not new in the Netherlands.

Several years ago, a similar debate focused on the standard resuscitation policy of residents of nursing homes.

It was then decided that nursing homes had the autonomy to establish their own resuscitation policies, provided they informed their patients properly.

Some nursing homes resuscitate their patients under all conditions, some never resuscitate any patients while others provide consent forms, enabling residents or their relatives to request resuscitation or non-resuscitation.

Following the debate about the Amersfoort elderly home this week, the Dutch Health Ministry emphasized that all homes for the elderly are likewise obligated to discuss the issue of resuscitation with residents and their families.

The St Pieters en Blokland Elderly Home is the first general elderly home - catering to some 98 healthy residents - to go public about its non-resuscitation policy.

But speaking on Dutch television on Wednesday, a spokesman for the Dutch heart patients foundation said several other homes for the elderly in the Netherlands have already implemented non-resuscitation policies similar to the one the Amersfoort home has now put on hold.

St Pieters en Blokland director Hans Olgers said earlier this week that his home had decided to launch the new policy following 'extensive inquiries among the residents about their wishes concerning resuscitation.'

'It turned out that most of our residents do not want to be resuscitated,' Olgers said earlier this week.

Part of the 'extensive inquiries' was a letter by the home addressed to all residents.

The letter stated that the quality of life of people over 70 deteriorates dramatically following resuscitation and asked its residents to indicate whether they wanted to be resuscitated.

However, the IGZ said there was no scientific proof for the home's claim that resuscitation would lead to a reduced quality of life.

'We have tried to start a debate about this issue very cautiously,' Olgers said on Dutch television.

He added he was 'surprised' by the public outcry following the home's announcement of its new policy, adding it had 'moved' him.

On Wednesday, the Dutch Heart Patients Foundation said that if the elderly do no want to be resuscitated, their wishes should be respected.

'Patients have the right of self-determination,' a spokesman of the organization said.

'If a patient does not want to be resuscitated, it is his right.'

On Tuesday, cardiologist Ruud Koster of the Amsterdam Medical Centre, the teaching hospital affiliated with the University of Amsterdam, slammed the non-resuscitation policy of the Amersfoort home in an article he wrote for Dutch daily newspaper NRC Handelsblad.

He particularly criticized the Amersfoort home's claim that the quality of life for people over 70 would deteriorate following resuscitation.

'Extensive scientific research has not proven any correlation between age and the quality of life following resuscitation,' Koster wrote.

According to Koster, a member of the Dutch and European Resuscitation Councils, the success rate of any resuscitation is about 15 per cent.

However, the quality of life following a successful resuscitation does not vary among age groups, he wrote.

'These people certainly do not get into a vegetative state, quite the contrary.'

In a study among resuscitated people Koster performed between 1995 and 2003, the cardiologist said he found that after resuscitation, 'more than 77 per cent of the people conducted independent lives, 85 per cent was physically independent and 84 per cent was cognitively independent.

'Only 10 per cent suffered slightly decreased functionality due to physical or cerebral problems.'