Senior Power: DNR

By Helen Rippier Wheeler
Tuesday May 03, 2011 - 08:39:00 PM

DNR can stand for a lot of things-- Department of Natural Resources, a House M.D. TV episode, Daily News Record, digital noise reduction… . Better familiarize yourself with its senior power significance:DO NOT RESUSCITATE

I have a homemade DNR notice on my apartment door. Firefighters/paramedics have naively asked me to put one on every door – I would if I could, for there are neighbors who assume they are protected in this respect! Even a DNR notice does not guarantee avoiding ending up on a ventilator or in the intensive care unit. I have also made clear with my primary care physician my DNR preference. It was part of our Advance Directive Discussion.  

About seven in ten Americans die with a DNR order instructing healthcare workers not to use life-prolonging treatment if their heart or breathing stops. But other situations not necessarily covered in DNR orders may also be worth considering. A new report shows DNR patients have a higher chance of dying following some surgical procedures. Ending up on a ventilator or in the intensive care unit is a possibility. DNR patients also had slightly more complications, such as stroke or pneumonia, but the outcomes depended on the type of surgery. The patient might prefer pain medication such as morphine to surgery. Overall, nearly a fourth of the DNR patients died in the month following their surgery -- about three times as many as in the comparison group. That difference remained even after taking into account that DNR patients are usually sicker to begin with. [Archives of Surgery, April 18, 2011.] 


AHCD stands for Advance Health Care Directive. In an AHCD you can define in advance what medical treatment you prefer and who you want to speak for you, assuming you possess trusted, nearby family members. It is often difficult for people to think about the care and treatment they want, or do not want, in the event that they are incapable of making their own health care decisions. You may unexpectedly be in a position where you cannot speak for yourself -- such as an accident or severe illness -- and be unable to make treatment decisions. An AHCD allows you to appoint an agent who has power of attorney to make care and treatment decisions on your behalf, and to give instructions about your health care wishes. AHCD forms are available online. 

The advance health care directive is also known as a living will, personal directive, advance directive, or advance decision A living will is one form of advance directive, leaving instructions for treatment. Another form authorizes a specific type of power of attorney or health care proxy, where someone is appointed by the individual to make decisions in their behalf when they are incapacitated. One may also have a combination. People should complete both documents in order to provide the most comprehensive guidance regarding their care. An example of a combination document in the United States is the Five Wishes advance directive. 

Five Wishes was originally introduced in 1996 as a Florida-only document,combining a living will and health care power of attorney in addition to addressing matters of comfort care and spirituality. A national version of Five Wishes was introduced in 1998. Five Wishes is available in 26 languages and in Braille. An online version called Five Wishes Online was introduced in April 2011 allowing users to complete the document using an online interface. 


POLST stands for Physician Orders for Life-Sustaining Treatment. A Physician Order Sheet is based on the person’s current medical condition and wishes. Your physician should provide you with a copy for you to record them. For example, Section A: No defibrillator (including automated external defibrillators) should be used on a person who has chosen “Do Not Attempt Resuscitation/DNR (Allow Natural Death).” You and your physician should review your POLST periodically. 



Attention Disabled Person Parking Placard-holders: Up to date placards good for two additional years are usually distributed by mail in April. If you have not received yours, it is time to look into it! 

California State Senator Lois Wolk (D-Davis) introduced legislation in March to strengthen the state ombudsman. "Senate Bill 345 works to provide more independent and cost-effective advocacy for seniors living in long-term care facilities who are among the most vulnerable citizens of California. … Our long-term care residents and local ombudsmen look to the state long-term care ombudsman for leadership. The bill will create the autonomy necessary for ombudsmen to fulfill their duties effectively." The state's long-term care ombudsman’s duties include investigating long-term care resident complaints, protecting the legal rights of residents, and publicizing issues of importance to residents. Currently, the state ombudsman is a politically-appointed position overseen by the Department of Aging, leading to concerns regarding the ombudsman's freedom to speak out on issues affecting long-term care residents. In 2009 (latest available data), 33,991 new cases were opened in California; 159,334 in the United States and District of Columbia. 

Grassroots organizations such as the Older Women’s and the Old Women’s Project are playing a key role in formulating national policies on aging, and in preserving the concerns of mid-life, older, and disadvantaged women. The median income in the U.S. for men over 65 is $29,171. The median income for women over 65 is $15,615. Globally, old women are the poorest of the poor. The OWL addresses the economics of women’s aging as well as other issues of social policy.  

Some academics estimate that one-third of the entire U.S. prison population will be more than 55 years old by 2030. The total number of elderly inmates is predicted to increase between four and seven times in the next 20 years, the fastest growing prisoner age group. The amount spent every year on corrections, which goes to keeping one in every 100 adult Americans behind bars, accounts for about seven percent of state budgets. ["US counts the cost of keeping elderly in jail," by Michael Stothard. Financial Times, London, UK, April 25, 2011].  

Doctors with specialties in aging are in short supply. Their shortage will worsen as the population ages in coming decades, a new report published this month in the Journal of the American Geriatric Society concludes. As the proportion of old adults spikes from 12 percent to a projected 20 percent by 2030, caring for 70 million people 65 and older and 10 million 85 and older will be a challenge. Fewer than 320 physicians entered geriatric medicine fellowship training from 2004 to 2008. At present, 80 percent of pediatric patients see pediatricians, while 80 percent of geriatric patients see primary care doctors or internists. Do as I do: see an internist who is a geriatrician!  

The California Senate Human Services Committee has approved a measure to reduce the time it takes for those required by law – police, bankers, physicians -- to report suspected elder abuse. Currently they may be kept on hold for lengthy periods when phoning in required alerts regarding San Diego County elders. The unanimous bipartisan vote sends the bill to the Senate Appropriations Committee. Legislation would permit reports to be submitted through a confidential Internet system. Several states, including Texas and Ohio, have implemented an Internet-based reporting system. The San Diego County District Attorney’s office receives on average about 845 calls monthly from those who suspect elder abuse or, in some cases, self-neglect because the person cannot take care of themselves or their finances. [San Diego Union-Tribune, April 26, 2011. Bill targets on-hold times for reporting elder abuseby Michael Gardner] 

Wednesday, May 412 noon – 1 PM. Albany Branch, Alameda County Library, 1247 Marin Av. Free. 1-on-1 Computer tutoring half hour computer tutoring, registration required: (510) 526-3720 x 16. (Also on Wednesdays, May 11, 18, 25) 

Wednesday, May 4Noon. Central Berkeley Public Library. Free. Playreaders. Information: (510)981-6100. (Also Wednesdays, 11, 18, 25)  

Thursday, May 510 AM. Central Berkeley Public Library. Free. Computer for Beginners. Information: (510)981-6100. Information: (510)981-6100. (Also Thursdays, May 10, 19, 26) 

Thursday, May 51:30-3 PM. Albany Branch, Alameda County Library, 1247 Marin Av. Free. Has parking lot (510 526-3720). Tips for Protection and Prevention. A free workshop by Legal Assistance for Seniors (LAS). No reservations required; refreshments. Wheelchair accessible. More information and other Alameda County Library branches’ dates for this program, at Library Senior Services (510) 745-1491.  

Saturday, May 7 2 PM. Central Berkeley Public Library. Free. Local Places…Sacred Spaces presents “Berkeley Partners for Parks,” a talk and slide show by the Berkeley Path Wanderers. Information and to confirm it is without charge: (510)981-6100. 

Thursday, May 12 6 PM South Berkeley Pubic Library. Free. Lawyers in the Library. Information: (510)981-6100. 

Helen Rippier Wheeler can be reached at Please, no email attachments or phone calls.