Resuscitation discussion practices: a survey of European geriatricians

Cardiopulmonary resuscitation (CPR) is a life-saving treatment, yet outcomes in frail older adults are poor. Despite this, decision-making around resuscitation remains complex, influenced by misperceptions among patients, families, and physicians. We aimed to describe current practices, identify difficulties and barriers regarding do-not-resuscitate (DNR) decisions, and to assess differences across Europe.

A cross-sectional online survey was conducted between September and December 2023, targeting geriatricians across Europe. The survey, disseminated via professional networks, assessed frequency and confidence in discussing DNR orders, barriers to discussions, and inter-country differences. Sociodemographic data and responses were analysed using descriptive statistics and logistic regression to identify factors influencing resuscitation discussions.

A total of 473 geriatricians participated across 22 countries (65% female, mean age 41.8 years, mean experience 10.5 years). Discussions of DNR orders occurred with ≥ 60% of hospitalised patients for 40% of respondents, with confidence discussing DNR orders reported by 80%. Reported barriers included time constraints (50%), cultural beliefs (25%), and lack of training (41%). Patients were kept 'for resuscitation' despite medical futility in an estimated 38% of cases at the request of patients or next of kin. Western European geriatricians discussed DNR orders more frequently and confidently than peers in other regions. Experience (> 20 years) was strongly associated with confidence (OR 7.53, 95% CI 1.93-32.35).

Significant variability exists in resuscitation discussions among European geriatricians, influenced by region, gender, and experience. Enhanced physician training, societal awareness, and standardised protocols could improve resuscitation decision-making and reduce inappropriate resuscitation attempts.