I recently had a patient who we had The Code Discussion with, a guy in his early 80s who had a hip replacement, and he emphatically said that he wanted to be DNR/DNI. We recorded his wishes in the chart. End of story, right?
Except the next day, the patient's wife called us into the room. She said she wanted to change her husband's status to full code. He wasn't particularly happy about it, but was agreeable. She said to him, "I'm not ready to lose you yet."
That story, to me, demonstrates two important facts about code status:
1) When elderly patients are made full code, it's often family members pushing for this status, rather than the patient himself.
2) People not in the medical field really just have no concept of what survival rates are when somebody goes through cardiopulmonary resuscitation.
For a patient over 70 years old, the chance of ever leaving the hospital after being resuscitated is only about 18%. But it gets better. If you do leave the hospital, you have a 60% chance of going to a nursing home, a 50% chance of having moderate to severe neurologic deficits, and a 50% chance of dying in the next year.
So basically, if you have CPR and are over 70 years old, your chances of returning home and not having severe disability are well under 10%. And the worst of it is that the person often pushing for the full code status isn't the patient who actually has to live through it.
I believe that patients over the age of 70 should not be given the option to be full code. That removes the stress and anxiety of having to make a decision, especially when the decision is not based on facts. Yes, maybe that 5% of people who would've lived happily for several more years might be sacrificed. But we will save 95% of people from weeks or months or even years of suffering, save probably millions on medical costs that could be better utilized, and also remove the guilt from family members.
But that's just my opinion. I could be wrong.