Success Rates of CPR in Older Adults Over 80 and the Implications for LTC Facilities

In a recent issue of the Journal of the American Geriatrics Society¹, study authors examined the prevalence of inappropriate cardiopulmonary resuscitation (CPR) on out-of-hospital patients aged 80 years and older. In addition, the study authors observed the outcomes of the intervention in this patient population.

For the study, health providers from Europe, Japan, Israel, and the US were surveyed, including 176 physicians, 123 nurses and 312 emergency medical technicians and paramedics. The authors asked about the last time that CPR was attempted in a patient 80 years or older.  Although 52.4% of the respondents believed that the intervention was appropriate, nearly 30% were uncertain, and 18.5% perceived CPR to be inappropriate in that individual. 

Among the group of respondents who felt the use of CPR was appropriate to utilize in older adults, the actual survival of these patients, as defined as alive at the time of discharge, was only 3%.  

Of 590 patients perceived as appropriate for intervention, CPR attempts were conducted for 124 patients in the long-term care setting, according to the survey. Of the 124 residents, the survival to hospital discharge was zero. Let me repeat that. There were no nursing home residents in this study who were successfully resuscitated. 

This research should prompt long-term care providers to address the utility of CPR in this setting. Long-term care facilities should:

• educate the resident and family;
• identify the need for physicians to take the principle responsibility in discussing the pros and cons of CPR with each and every resident; and
• understand the impact of performing CPR on a resident in this age group. 

Of important note, we must also consider the effect CPR may have on the staff, particularly if they are responsible for attempting to resuscitate every individual who lacks a valid DNR order.    

Ilene Warner-Maron, PhD, RN-BC, CWCN, CALA, NHA, FCPP, has been practicing nursing for 33 years, specializing in the care of geriatric patients. Dr. Warner-Maron is the president of the Institute for Continuing Education and Research, providing educational programs for individuals seeking licensure in nursing home administration.  

Reference:

1. Druwé P, Benoit DD, Monsieurs KG, et al. Cardiopulmonary Resuscitation in Adults Over 80: Outcome and the Perception of Appropriateness by Clinicians. J Am Geriatr Soc. 2020;68(1):39–45. doi:10.1111/jgs.16270