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.'
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