[End-of-life care in emergency settings in the super-aged society: withholding CPR from frail elderly with severe ADL impairment].

Emergency and intensive care unit demographics have changed with the advent of the super-aged society in Japan. Japan has the highest population aging rate in the world. It is now predicted that an increasing number of people will die at higher age. The oldest old individuals show increasing frailty, with an excess vulnerability to stressors. It is believed that frail elderly would receive limited benefit from highly invasive emergency treatment and advanced intensive care which, on the contrary, could bring about harmful effects on frail elderly. So far a number of frail oldest-old nursing home residents with cardiopulmonary arrest have been taken by ambulance to emergency medical centers to receive cardio-pulmonary resuscitation in vain in Japan. Now is the time to stop the harmful ritual. Withholding CPR from frail elderly with severe ADL impairment would not constitute an act of ageism but the act of humanity based on medical evidence.