Elderly exclusion from hospital/ICU

jibber5000

jibber5000 wrote: »

It's not based on age. An 87 year old with zero comorbidites would have a 53% 10 year survival and thus would be ventilated.

A 75 year old with kidney disease diabetes heart failure and copd would have a 0% 10 year survival so wouldn't be ventilated.

It's based on clinical judgment not age

Agree with the general point you're making, but how does an 87 year old (covid or no covid) have a 53% chance of surviving to 97? They've already gone several years past the average life expectancy by 87. The majority of people don't make it to their late 90s.

plodder

KiKi III wrote: »

This happens all the time across our health service and around the world.

If you’re diagnosed with cancer at 65 you might be offered chemo, whereas with the same cancer at 85 you would be offered palliative care.

It’s about the likelihood the treatment would work, and also whether ongoing treatment is a better decision than palliative care.

It might not be quite as stark as that even. My mother was in her early 80's when she got cancer (again) and she got chemo. Due to complications and probably her age she was not able to complete the treatment, and it ended up with palliative care. The point is that age is only one factor. They don't just give up on old people. If they are healthy otherwise, the system tries its best I think.

Being resuscitated, intubated, put on a ventilator only to die a few days later anyway is a horrible way to spend your last few days on earth.

True

plodder

KyussB wrote: »

It's certainly not that way for the wealthy. No chance in fuck of that.

This isn't a cancer diagnosis with ultra-expensive pharma treatment options - it's a global pandemic that we were promised equal treatment on.

You are 100% wrong. Cancer treatment in this country is good for everyone, rich or poor. Same goes for this pandemic.

Salty

is_that_so wrote: »

Henry has commented at length about how they approach nursing homes and that they determine where the greatest benefit might be to the patient. Oftentimes staying where they are may be the best place for them.

Absolutely this - decisions are made on an individualised basis, taking into account the whole clinical picture of the person. There is a difference between preserving life and prolonging death. Quality of life and dignity are of utter importance.

I've mentioned him before in this forum somewhere, but my Grandad died just over 14 months ago. He had suffered a stroke 12 months prior to his death. In his final days, he stopped taking fluids and nutrition. Sure, the nursing home staff could have tube fed him to keep him alive for a few more days or weeks...but would this have really been in his best interests? In the end, he passed away peacefully.

splinter65

plodder wrote: »

It might not be quite as stark as that even. My mother was in her early 80's when she got cancer (again) and she got chemo. Due to complications and probably her age she was not able to complete the treatment, and it ended up with palliative care. The point is that age is only one factor. They don't just give up on old people. If they are healthy otherwise, the system tries its best I think.

True

We’ve developed a huge complex around the whole area of growing old and eventually dying.
British people have suffered with this for years but it’s only recently taken hold here.
It’s seems that it’s not that people don’t accept that they will grow old. You’d need to be a certified idiot to believe that. It seems that people don’t accept that they will grow old and that their bodies will slowly start to let them down. They seem to think that they will somehow ward off the natural disintegration of their flesh and bones or maybe they think that there will be side affect free pharmaceuticals that will allow them to function well into their second century much as they do now.
People are afraid of death and dying now and I know lots of adults with ageing parents who not only can’t contemplate their own death but cannot countenance a world without their parents in it either.
Old people used to be allowed to die a natural dignified death but now medics have to do battle with irate distressed adult children who are willing to let their parent suffer on on a ventilator neither dead nor alive because they simply can’t let go.

splinter65

Salty wrote: »

Absolutely this - decisions are made on an individualised basis, taking into account the whole clinical picture of the person. There is a difference between preserving life and prolonging death. Quality of life and dignity are of utter importance.

I've mentioned him before in this forum somewhere, but my Grandad died just over 14 months ago. He had suffered a stroke 12 months prior to his death. In his final days, he stopped taking fluids and nutrition. Sure, the nursing home staff could have force fed him to keep him alive for a few more days or weeks...but would this have really been in his best interests? In the end, he passed away peacefully.

My relative in law was at home dying on a morphine drip some years ago after a long agonising battle with illness during which no stone was left unturned in the pursuit of a return to good health.
family all gathered round. I was staggered to overhear an adult daughter a normally sensible educated professional girl ask the palliative care nurse who would resuscitate her mother should she stop breathing.
The nurse gently pointed out to the mounting horror of the woman that there would be no resuscitation and that the end of her mothers suffering was very near.
It has taken them years longer to grow accustomed to her death because the levels of denial and refusal to accept mortality was so strong.

Salty

splinter65 wrote: »

My relative in law was at home dying on a morphine drip some years ago after a long agonising battle with illness during which no stone was left unturned in the pursuit of a return to good health.
family all gathered round. I was staggered to overhear an adult daughter a normally sensible educated professional girl ask the palliative care nurse who would resuscitate her mother should she stop breathing.
The nurse gently pointed out to the mounting horror of the woman that there would be no resuscitation and that the end of her mothers suffering was very near.
It has taken them years longer to grow accustomed to her death because the levels of denial and refusal to accept mortality was so strong.

Unfortunately, families really struggle to accept that a loved one in this situation is in fact dying a natural death, as it were. Prolonging someone's natural death does not benefit that individual.

splinter65

Salty wrote: »

Unfortunately, families really struggle to accept that a loved one in this situation is in fact dying a natural death, as it were. Prolonging someone's natural death does not benefit that individual.

It’s also a modern phenomenon.

the14thwarrior

It is a HIQA requirement, and best practise and most Nursing homes have "an end of life " plan. whether DNR orders would be needed. usually by first week admission in the NH, so regardless of the cause of death, covid, pneumonia, stroke most people in NH have a DNR order done.

this must be done in consultation with the patient, the family, NOK, doctor. at the end of the day though the doctor has the final say. but it rarely comes to the doctor only. having years of experience i know this to be true.

most people in nursing homes have a DNR on them. that means that they will not be resusitated or ventilated. they can be given oxygen to ease pain and suffering.

the irish hospice foundation, have a program called CEOL - compassionate end of life - and it is widely followed.

most of the deaths in this country have been in nursing homes.
the nursing home staff have been badly hit.
PPE or lack of shocking. shocking.
it will change but too late for some people.....

lozenges

splinter65 wrote: »

My relative in law was at home dying on a morphine drip some years ago after a long agonising battle with illness during which no stone was left unturned in the pursuit of a return to good health.
family all gathered round. I was staggered to overhear an adult daughter a normally sensible educated professional girl ask the palliative care nurse who would resuscitate her mother should she stop breathing.
The nurse gently pointed out to the mounting horror of the woman that there would be no resuscitation and that the end of her mothers suffering was very near.
It has taken them years longer to grow accustomed to her death because the levels of denial and refusal to accept mortality was so strong.

Can relate to this from the other side. I'm a healthcare professional and while most families are extremely, extremely understanding when it comes to a discussion about end of life care there are a proportion of people who have great difficulty acknowledging mortality.

looksee

The conspiracy theory types who love to mutter darkly about killing off old folk and letting people die for financial reasons are talking dangerous rubbish.

When my husband was dying there was no point asking him about the DNR (do not resuscitate) as he was in complete denial up to the very end. I was asked not so much for permission as to say I understood why there would not be any further resuscitation after that admission to hospital. The main point was that if he were put on a ventilator there would be no question of being able to take him off it to breath by himself, due to the severity of the disease. They were not prepared to put him on a ventilator indefinitely with the prospect of having to pull the plug at some stage anyway. He went home and died about 2 weeks later, peacefully at home, where he wanted to be.

In the Covid 19 situation, I am in the grouping that is being discussed and even though I am still leading a normal life I would not want to be put on a ventilator. I think it is only a matter of time before it is realised that it is not a solution for everyone, especially not for older people with underlying problems, their chances of surviving being on a ventilator, undamaged, are minimal.

Ace2007

Flying Fox wrote: »

Agree with the general point you're making, but how does an 87 year old (covid or no covid) have a 53% chance of surviving to 97? They've already gone several years past the average life expectancy by 87. The majority of people don't make it to their late 90s.

The majority may not, but for those that do, they must be quite strong.

One in five twenty year old's today will make it to 100, due the medical advances, so people are living longer

JP Liz V1

The nursing homes worldwide seem to be let down in this Covid battle, high rates of deaths not just Ireland, it's like no effort to help is even being made, just left to die

I think the HSE and Dept of Health have failed, they could have better prepared

I feel for anyone in a nursing home, care home or residential care facility and their families, tough time

iamwhoiam

JP Liz V1 wrote: »

The nursing homes worldwide seem to be let down in this Covid battle, high rates of deaths not just Ireland, it's like no effort to help is even being made, just left to die

I think the HSE and Dept of Health have failed, they could have better prepared

I feel for anyone in a nursing home, care home or residential care facility and their families, tough time

Left to die ? Have you any evidence at all that anyone is left to die ?

beauf

JP Liz V1 wrote: »

The nursing homes worldwide seem to be let down in this Covid battle, high rates of deaths not just Ireland, it's like no effort to help is even being made, just left to die

I think the HSE and Dept of Health have failed, they could have better prepared

I feel for anyone in a nursing home, care home or residential care facility and their families, tough time

They can't find it. There's been a funding crisis in nursing homes for a long time widely reported in the media. Fair deal is underfunded. Can't get staff, staff are poorly paid. We were warned.

JP Liz V1

iamwhoiam wrote: »

Left to die ? Have you any evidence at all that anyone is left to die ?

Spain launches criminal investigation into 37 care homes after thousands of elderly coronavirus victims were left to die

https://bigworldtale.com/world-news/spain-investigates-37-care-homes-after-covid-19-victims-left-to-die/

spatchco

hope if i was unfortunate to contact covid-19 that doctors respect my wishes DNR

iamwhoiam

JP Liz V1 wrote: »

Spain launches criminal investigation into 37 care homes after thousands of elderly coronavirus victims were left to die

https://bigworldtale.com/world-news/spain-investigates-37-care-homes-after-covid-19-victims-left-to-die/

Were you not talking about the HSE and Ireland ?

JP Liz V1

iamwhoiam wrote: »

Were you not talking about the HSE and Ireland ?

Worldwide

beauf

JP Liz V1 wrote: »

The nursing homes worldwide seem to be let down in this Covid battle, high rates of deaths not just Ireland, it's like no effort to help is even being made, just left to die

I think the HSE and Dept of Health have failed, they could have better prepared

I feel for anyone in a nursing home, care home or residential care facility and their families, tough time

You are conflating other countries with the HSE and Ireland. Which is disingenuous.

JP Liz V1

beauf wrote: »

You are conflating other countries with the HSE and Ireland. Which is disingenuous.

I still think the HSE and Dept of Health failed here with nursing homes, these should have been one of the first looked after with PPE and testing

beauf

JP Liz V1 wrote: »

I still think the HSE and Dept of Health failed here with nursing homes, these should have been one of the first looked after with PPE and testing

Before ICU?

Nursing homes are in general not medical facilities. You are not going to make then medically isolated in a few weeks. They don't have the staff.

The point remains about talking about other countries and HSE together.

the14thwarrior

it was a cluster##k waiting to happen.
they didn't put enough resources into the nursing homes initially
PPE equipment not available, locked up since early march, testing in general a bit of a failure.
they have no staff, half out sick, half on stress and tiredness, OT, SLT, PT filling the gaps in places.
a big effort made to take people in from acute hospitals - this happened, and the money was made available to purchase all manner of equipment.

yes the focus was on the hospitals.
but now the focus is on the nursing homes

they didn't do it on purpose
mistakes were made, they now need to rectify them
which in fairness they are.
sad....

beauf

As soon as one staff member has symptoms they isolate leaving the place short handed. By the time someone has symptoms they could have had it for a week.

We were only testing people with symptoms. There was no capacity even for this at the start.

It's not time to be pointing fingers. Extend the helping hand. Very tough job working in nursing homes even normally.

pinkyeye

They are still not prioritising testing for staff of nursing homes. I know personally of 3 people self isolating whilst they await the results of their tests. They'll be recovered before they get the results. If priority was given to their tests they could get back to work or at least let the nursing home know there was a danger of an infection being in the home.