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| Journal of the New Zealand Medical Association, 11-May-2012, Vol 125 No 1354 |
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[full text] [PDF] Old Man’s Friend? Resuscitation decisions in patients hospitalised with pneumonia
David G Tripp
AbstractBackground Community-acquired pneumonia (CAP) is a common illness, for which hospitalisation leads to significant inpatient and subsequent mortality. The frequency and timing of discussion of end-of-life issues with these inpatients is therefore relevant. Aim To determine whether end-of-life discussions occurred for patients with CAP whose prognostic indicators suggested a high risk of dying. Methods A retrospective review of 155 admissions with CAP was conducted. The nature and timing of resuscitation decisions were correlated with age, illness severity and mortality. Results Mortality following admission with CAP increases with age and severity. Of those over 65, 37% die within 12 months of discharge; 11% die on the index admission, and a further 26% die in the 12 months following discharge. Mortality increases dramatically with older age: those over 80 had a 47% 12-month mortality. End-of-life decisions were documented prior to death for all inpatient deaths. However, end-of-life decisions were only documented in a minority of other cases, even amongst those with highest risk of subsequent mortality. Conclusions In a common illness with significant mortality, opportunity exists to better identify those at high risk of mortality and initiate discussions about end-of-life care. A not-for-resuscitation discussion currently appears to function as a surrogate marker for impending death rather than an opportunity to elicit a patient’s wishes for their care should they be at high risk of dying in the near future.
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