Discomfort in Nursing Home Patients With Severe Dementia in Whom Artificial Nutrition and Hydration Is Forgone

2005 ◽  
Vol 165 (15) ◽  
pp. 1729 ◽  
Author(s):  
H. Roeline W. Pasman ◽  
Bregje D. Onwuteaka-Philipsen ◽  
Didi M. W. Kriegsman ◽  
Marcel E. Ooms ◽  
Miel W. Ribbe ◽  
...  
Keyword(s):  
Nursing Home ◽  
Artificial Nutrition ◽  
Severe Dementia ◽  
Artificial Nutrition And Hydration ◽  
Nursing Home Patients ◽  
Nutrition And Hydration

Predictors of survival in nursing home patients with severe dementia in whom artificial nutrition and hydration forgone

2006 ◽  
Vol 18 (2) ◽  
pp. 227-240 ◽  
Author(s):  
H. Roeline W. Pasman ◽  
Bregje D. Onwuteaka-Philipsen ◽  
Didi M. W. Kriegsman ◽  
Marcel E. Ooms ◽  
Gerrit van der Wal ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Clinical Judgment ◽  
Strong Predictor ◽  
Artificial Nutrition ◽  
Severe Dementia ◽  
Artificial Nutrition And Hydration ◽  
Nursing Home Patients ◽  
Nutrition And Hydration

Background: To investigate the characteristics of patients in whom artificial nutrition and hydration (ANH) is forgone, duration of survival after the decision and factors that are associated with duration of survival.Methods: Observational study based on written questionnaires in 32 Dutch nursing homes. Of 178 nursing home patients with dementia, their treating nursing home physician (NHP) filled in a questionnaire directly after the decision was made to forgo ANH. The maximum follow-up was 6 weeks. Cox proportional hazards analysis was used to determine predictors of survival.Results: Decisions to forgo ANH in Dutch nursing homes were made most often in patients with severe dementia who also had an acute illness. More than half the patients (59%) died within 1 week after the decision. Patients with dyspnea and/or apathy were more likely to die during follow-up than patients without these symptoms. Patients who were considered more severely ill by the NHP were more likely to die than those who were considered less severely ill. The presence of restlessness indicated a higher chance of survival.Conclusions: The clinical judgment of the NHP of the severity of illness appeared to be a strong predictor of patient survival. NHPs should not rely solely on their clinical judgment concerning survival, but they should also consider the presence or absence of dyspnea, apathy and restlessness.

Forgoing Artificial Nutrition and Hydration in Nursing Home Patients With Dementia

2004 ◽  
Vol 18 (3) ◽  
pp. 154-162 ◽  
Author(s):  
H Roeline W Pasman ◽  
Bregje D Onwuteaka-Philipsen ◽  
Marcel E Ooms ◽  
Petra T van Wigcheren ◽  
Gerrit van der Wal ◽  
...  
Keyword(s):  
Nursing Home ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Nursing Home Patients ◽  
Nutrition And Hydration

Participants in the decision making on artificial nutrition and hydration to demented nursing home patients: A qualitative study

2004 ◽  
Vol 18 (3) ◽  
pp. 321-335 ◽  
Author(s):  
H.Roeline W Pasman ◽  
B.Anne Mei The ◽  
Bregje D Onwuteaka-Philipsen ◽  
Miel W Ribbe ◽  
Gerrit van der Wal
Keyword(s):  
Decision Making ◽  
Nursing Home ◽  
Qualitative Study ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Nursing Home Patients ◽  
Nutrition And Hydration

scholarly journals Nutrition in Severe Dementia

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Glaucia Akiko Kamikado Pivi ◽  
Paulo Henrique Ferreira Bertolucci ◽  
Rodrigo Rizek Schultz
Keyword(s):  
Respiratory Diseases ◽  
Pharmacological Therapy ◽  
Artificial Nutrition ◽  
Feeding Problems ◽  
Severe Dementia ◽  
Artificial Nutrition And Hydration ◽  
Mineral Supplementation ◽  
Advanced Stages ◽  
Nutrition And Hydration ◽  
Vitamin And Mineral Supplementation

An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.

Views of Registered Dietitians Compared to Speech-Language Pathologists on Artificial Nutrition and Hydration at the End of Life

2021 ◽  
pp. 104990912199431
Author(s):  
Molly K Bigford ◽  
Roschelle Heuberger ◽  
Erica Raymond ◽  
Viki Shayna ◽  
James Paauw
Keyword(s):  
End Of Life ◽  
Terminal Illness ◽  
Descriptive Analysis ◽  
Study Patient ◽  
Artificial Nutrition ◽  
Speech Language Pathologists ◽  
Artificial Nutrition And Hydration ◽  
Nutrition And Hydration ◽  
Evidenced Based ◽  
Registered Dietitian Nutritionists

Objective: To analyze and compare the knowledge and opinions of registered dietitian nutritionists (RDNs) about artificial nutrition and hydration (ANH) in a terminal illness. Beliefs of speech-language pathologists (SLPs) were also considered and compared against RDN data. Methods: This is a descriptive analysis utilizing survey responses from RDNs and SLPs regarding ANH in a case study patient with advanced dementia. Results: There was a strong belief among RDNs that ANH at end of life (EOL) would improve nutritional status, although a correlation was found between those in favor of ANH and believing it was ethical to withhold ANH at EOL (R2 = 0.109, p = 0.002). Responses indicated that SLPs need more education regarding ANH techniques, while RDNs felt ANH would improve aspiration risk. Place of employment, religion and age of respondents were also found to impact beliefs. Conclusion: Clinicians, specifically RDNs, working with patients at EOL need more evidenced-based education on the risks and benefits of ANH. Decisions regarding care of patients at EOL should be void of clinicians’ personal bias which may affect ethical treatment in the clinical setting. Further controlled trials must be performed before claims can be made regarding ANH at EOL.

scholarly journals Observations on the Ethical and Social Aspects of Disorders of Consciousness

2010 ◽  
Vol 37 (6) ◽  
pp. 758-768 ◽  
Author(s):  
Eric Racine ◽  
Catherine Rodrigue ◽  
James L. Bernat ◽  
Richard Riopelle ◽  
Sam D. Shemie
Keyword(s):  
Life Support ◽  
Functional Neuroimaging ◽  
Vegetative State ◽  
Clinical Care ◽  
Disorders Of Consciousness ◽  
Artificial Nutrition ◽  
Artificial Nutrition And Hydration ◽  
Neuroscience Research ◽  
Nutrition And Hydration ◽  
Unconscious Patients

AbstractThe care of chronically unconscious patients raises vexing medical, ethical, and social questions concerning diagnosis, prognosis, communication with family members, and decision making, including the withdrawal of life support. We provide updates on major controversies surrounding disorders of consciousness. Issues such as withdrawal of artificial nutrition and hydration – which had been considered “settled” by many in the medical, legal and ethical communities – have resurfaced under the pressure of social groups and religious authorities. Some assumptions about the level of awareness and the prognosis of vegetative state and minimal conscious patients are questioned by advances in clinical care because of insights produced by neuroscience research techniques, particularly functional neuroimaging. Both the clinical and neuroscience dimensions of disorders of consciousness raise complex issues such as resource allocation and high levels of diagnostic inaccuracies (at least, for the vegetative state). We conclude by highlighting areas needing further research and collaboration.

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