When is it appropriate to DNR?

I would say never appropriate just ban them because they are dangerous and are abused, so the staff can get out of working.

Sunnygirl1, I am so glad that you were close enough to your cousin to have a good feel for what she would want. That makes your decisions easier to make, I would think.

Thank you for all the input. This does help me.

I have her POA and Health Care POA. In the Healthcare POA, she gives me unlimited authority on al health carel issues, including hydration. She didn't do a Living Will though. I'm confused about that.

I have spoken with her, (she's my cousin, but I'm the only family member alive and willing to be involved.) about this issue, though she didn't know she had this condition then. She never wanted prolonged suffering. She watched her dad suffer and then die with lung cancer, plus he had AD. Then she watched her mom in the NH for a short time, when she signed DNR for her mom. She said her mom wanted that. She was in her 80's and had cancer. Her mom told me she was ready to go. She did soon after.

So, I think I have a good idea of what my cousin would want. She also has diabetes, hypertension and a couple more conditions. I'm going to talk to her doctor and then revisit the matter.

I wouldn't sweat this too much, Sunnygirl. Yes, I agree, ideally one would have all of these decisions made well in advance, or at least have discussed them with one's loved ones, the theory being that then everyone knows what the person's wishes are (assuming, of course, that those wishes don't change…) - but in reality, on the scene, in the NH, your mother's doctors will act in what they believe to be her best interests, based on their best clinical judgment.

Of course, if there is a DNR in place it is reassuring for the staff, because they then don't have to explain to grieving relatives why they didn't even try, and for the relatives because they won't have that awful hollow feeling of wondering if more could have been done. But in the end it isn't likely to be all that significant.

It's a bit different if an elder is still trundling around in the community, because paramedics, first aiders, even helpful passers-by, can't use their discretion in the same way as an NH's doctor. But what everyone is trying to avoid is both a) needless death and b) needless, futile and incredibly violent medical treatment; finding the path between that Scylla on the one hand and Charybdis on the other is a task you can only give your best shot if and when it happens; and I don't think there's much cynicism at large on this issue, not really. People do their best to make the right call in the circumstances.

Don't be anxious, either, that a DNR would mean that your mother wouldn't be treated for minor ailments: she would. DNR should apply to a well-defined range of treatments, mainly CPR, which include heroic measures that are often unsuccessful even in much younger people. If, God forbid, your mother had a cardiac or respiratory arrest tonight, what would you want done to her in the hope of saving her life? If you're feeling strong-stomached, have a good look on line at what exactly these procedures entail, and what their success rates are, before you make your mind up. I'm not being callous: speaking for myself, seeing what was involved changed my mind quite a bit about what it would be "worth trying."

Then again, some frail elderly people can be absolute troupers and terriers when it comes to keeping going at all costs. If your elder is one of those, by all means back her up!

Ashlynne's conclusion is one I entirely share: it is lovely not to be the person who has to decide.

Mom went into AL with unspecified dementia post stroke. She did not want a DNR, but she did sign advanced directives for no respirator, no feeding tube, but yes to fluids, pain meds and antibiotics. There are many options.
Your loved one in early to mid stage Alzheimer's may want a DNR and that is ok. But when the patient is not responsive or in a coma and requires repeated CPR to keep going, it might be kinder to sign the DNR. You are not at that juncture yet.

My mother is in nursing home (parkinsons, numerous strokes and dementia). When she broke a hip over a year ago the hospital asked me (as POA) if I wanted DNR and I chickened out but my mother was of more sound mind then and insisted on a DNR. For me it was an awful decision to have to make. Supposing resuscitation could provide a decent quality of life for a bit longer, supposing it just meant prolonged suffering? I am so very grateful I didn't have to make that decision.

I absolutely agree with all the above. End of life choices should be made long before these decisions are necessary. Adding to the above even if your loved one were to survive the CPR there is the added danger that the brain may be severely damaged and the rest of life lived in a comatose state. At 75 I am in reasonable health and would expect CPR but would not wish to continue on life support for more than a few days if there was no hope of recovery. This is all made clear in my living will and my husband and children know my wishes

DNR is a personal decision based on many factors.

If there is no DNR on record at the AL facility some attempt may be made to resuscitate your loved one.

While Dr.'s will follow family wishes it is very difficult for all involved to resuscitate someone with a terminal illness. It's brutal to flog on someone who is weak and terminally ill.

Alzheimer's is a terminal illness. If your loved one were to go into cardiac arrest and there is no DNR on file some attempt will be made to either call an ambulance or administer CPR right there. She will be taken to the hospital where she may be subjected to having her heart shocked (with the paddles) and/or intubated so that she is on a ventilator that is breathing for her. Her ribs may break from CPR or other life-prolonging attempts. This is sometimes accompanied by a collapsed lung whereby a chest tube will be inserted to reinflate the lung.

I don't know if Dr.'s really recommend a DNR but they have a responsibility to let the family know what resuscitation entails. I also don't know what is "common" but many people don't want to see their loved one go through something like this when they are terminally ill. It's not peaceful, it's not dignified, and at times it's what the family wants as opposed to what the ill person would want.

While I know there are "stages" of Alzheimer's, I believe they are for diagnostic purposes only. "Stages" can be very subjective.

I don't know what kind of a life your loved one has right now. I don't know how advanced the disease is. The thing about a DNR is doing what you think your loved one would want, not what you'd prefer. We'd all prefer to postpone the inevitable because we know how much it's going to hurt but we have to put our loved one first above our desires and wants.

If my loved one had "moderate to severe" Alzheimer's I would definitely want a DNR in place and would have hopefully discussed this with my loved one when the diagnosis was first made. But if it wasn't discussed and there is no DNR in place because my loved one can't understand the implications I would order a DNR in an emergency as next of kin or POA. A DNR can be signed in an ER or in the middle of any kind of emergency. I would want to my loved one to slip from this world peacefully and naturally.