ArcaMax

DEAR DR. ROACH: I am an 80-year-old man in reasonably good health. The only medications that I take are Eliquis for atrial fibrillation, omeprazole for gastroesophageal reflux disease, and terazosin and finasteride for benign prostatic hyperplasia. I exercise and remain active and independent.

My primary care provider told me on my last visit that now that I am 80, I should seriously consider adding a "do not resuscitate" (DNR) clause to my advanced medical directive. I was told that people over 80 have only about a 5% chance of recovering to the point where they can resume a meaningful, active lifestyle. Is a DNR clause a reasonable decision for me? I do not want to be bedridden in a nursing home or at home. -- D.S.

ANSWER: I agree with your primary care provider that it is worth having a health care directive so that your wishes are known. The decision to put a DNR clause into your medical directive is a bit more nuanced than the bleak number he gave you, as the ability to return to a good quality of life depends on the cause of the cardiac arrest and the medical conditions that the person has.

For people who have in-hospital cardiac arrest in their 80s, only about 15% will survive to be discharged from the hospital. However, those who survive usually have a good quality of life, with about 90% having good cerebral performance or at least being able to care for themselves.

When I discuss this with my patients who are generally healthy, like you, I advise them against an absolute order for or an attempt at resuscitation unless they feel very strongly about it. In a case of sudden cardiac arrest, such as a heart attack, a rapid return to a normal heart rhythm through fast CPR and successful intervention often leads to the good outcomes that are seen in the statistics above.

When a person has a chronic, progressive disease like cancer, then an attempt at resuscitation is very unlikely to lead to the resumption of the meaningful, active lifestyle that you have and want to keep. So, I advise using terminology in the medical directives so that your providers can choose whether an attempt at resuscitation is appropriate.

I wouldn't want you to deprive yourself of the chance for a quick recovery from an abnormal heart rhythm, but most people who have seen their loved ones in a facility without a good quality of life do not want this for themselves.

DEAR DR. ROACH: I am a 73-year old female in very good health. I have no history of cardiac or clotting issues. For decades, I took a daily low-dose aspirin, in part because we travel abroad frequently and take long flights. I recently stopped taking aspirin after reading numerous reports that the risks outweigh the benefits in older people.

Should I be taking aspirin (or something else) prior to flying? If so, what and at which dose? I do wear compression socks and stay well-hydrated on flights. -- E.M.E.

ANSWER: The risk of developing a blood clot during a flight is very small. For flights that are less than 4 hours, there is almost no risk. On longer flights, the risk is about 1 in 5,000 people. There is good evidence that aspirin is not helpful at reducing this already low risk. Even more powerful medicines like enoxaparin did not have a provable benefit in a trial.

I do recommend compression stockings for my patients who are at a higher risk, and I do recommend staying hydrated and walking every hour or so; getting an aisle seat on longer flights is wise.

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Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu.

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