Why do older people refuse resuscitation? A qualitative study examining retirement village residents’ resuscitation decisions

Abstract

Background: There is a dearth of qualitative research on resuscitation preferences of older New Zealanders. The aim of this study was to investigate the resuscitation preferences of older New Zealanders in a retirement village or residential care setting, as well as the reasons for these preferences. Methods: This study had 37 participants from two retirement villages in Auckland, New Zealand. Participants were interviewed about a hypothetical case vignette about cardiopulmonary resuscitation, and then they completed a semi-structured interview. Interviews were subsequently transcribed and analyzed by two independent researchers using thematic qualitative methodology. Results: The majority of the participants (n = 25, 67.6%) decided against resuscitation, 10 (27.0%) wanted resuscitation, and 2 (5.4%) were ambivalent about their resuscitation preferences. Three main themes emerged during the data analysis regarding participants' reasons for deciding against resuscitation: (i) the wish for a natural death; (ii) advanced age; and (iii) a realistic awareness about the consequences of resuscitation. Responses related to the third these had three subthemes: (i) reduced quality of life; (ii) loss of personal integrity and sense of existence; and (iii) concern that resuscitation could result in unnecessary costs or a burden on others. Among participants who preferred resuscitation, two main themes emerged regarding their reasons for wanting resuscitation: (i) the wish to prolong a good quality of life; and (ii) unrealistic expectations of resuscitation. Conclusions: Older people in this study were able to make reasoned decisions about resuscitation based on balancing their subjective estimations of quality of life and the presumed consequences of resuscitation. It is important therefore to educate older adults about the potential outcomes of resuscitation and explore (and document) their reasoning when discussing resuscitation preferences so their wishes can be respected.

Do not attempt cardiopulmonary resuscitation decision-making process: scoping review

“…40 Factors that influenced the decision were the wish for a natural death, advanced age and a realistic awareness about the consequences of resuscitation. 57…”

What matters and influence resuscitation preference? Development, field testing, and structural validation of items among older patients in the emergency department

“…However, as stated in the early interviews from an old independently living man: "It's just a good life that comes to an end" [5]. Evidence is sparse, but older people living independently may not wish to gamble with the outcome of a cardiac arrest if resuscitated [38]. Regardless, resuscitation decision making and goals of care conversations (e.g., Advance Care Planning) needs to be performed before the patients become incapacitated when aiming for fulfillment of patient preference [39].…”