Do-Not-Resuscitate Orders

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Abstract
CARDIOPULMONARY resuscitation (CPR) of elderly, chronically ill patients is an important, emotion-laden issue for many administrators, physicians, and nurses working in nursing homes and chronic-care hospitals. Resuscitations in these settings evoke thoughts and images that are not necessarily associated with resuscitations in a younger, healthier population. When an emphysematous nonagenarian lies on the floor, ashen, with a handful of nurses compressing his chest and breathing through his mouth, a sense of futility permeates the room. After each such episode in a long-term-care (LTC) facility, one wonders if indeed this effort is futile. And if it is, why do we do it? Most of the literature on resuscitation focuses on policies and outcomes in acute-care hospitals. However, the dilemmas encountered in LTC institutions are also substantial. Beds in LTC facilities already outnumber acute-care hospital beds in the United States,1and the difference is expected to grow as the population ages.

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