Feeding Tubes in Patients with Sever Dementia -- American Family Physician

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www.aafp.org/afp AMERICAN FAMILY PHYSICIAN 1605 ing artificial nutrition and hydration to patients with severe dementia. These techniques have been promoted as a method to improve nutrition, maintain skin integrity by enhanced protein intake, prevent aspiration pneumonia, minimize suffering, improve functional status, and extend life. Additionally, providing artificial nutrition and hydration has been associated with caring and nurturing whereas forgoing these measures has been equated with neglect and abandonment. Thus, when caretakers are faced with the decision of whether or not to provide artificial nutrition and hydration, it seems sensible to provide it by any means. Percutaneous endoscopic gastrostomy (PEG) tubes often have been used for this purpose, and it is estimated that approximately 30 percent of all PEG tubes are placed in patients with dementia. Unfortunately, most of the data regarding feeding tubes in severely demented patients are based on observational studies, retrospective studies, or data extrapolated from mixed populations. These factors may significantly confound the ability to appropriately assess the risks and benefits of feeding tube placement. Variability in aspiration pneumonia, functional status, and mortality rates may be T he use of artificial nutrition and hydration in patients in the final stages of dementia is a controversial and emotional issue. This topic will become increasingly important because the prevalence of dementia will continue to rise as the population ages. The most common form of dementia is Alzheimer’s disease, and its prevalence will nearly quadruple in the next 50 years, by which time approximately one in 45 Americans will have the disease. In the end stages of dementia, patients are typically incapable of having relationships with other people, bedridden, incontinent, and unable to eat and drink for various reasons. Problematic eating patterns may include indifference to food, refusal of food, or failure to manage the food bolus properly once it is in the mouth. Family members and physicians are often attracted to the perceived benefits of providPatients with advanced dementia are among the most challenging patients to care for because they are often bedridden and dependent in all activities of daily living. Difficulty with eating is especially prominent and distresses family members and health care professionals. Health care professionals commonly rely on feeding tubes to supply nutrition to these severely demented patients. However, various studies have not shown use of feeding tubes to be effective in preventing malnutrition. Furthermore, they have not been demonstrated to prevent the occurrence or increase the healing of pressure sores, prevent aspiration pneumonia, provide comfort, improve functional status, or extend life. High complication rates, increased use of restraints, and other adverse effects further increase the burden of feeding tubes in severely demented patients. Feeding tubes should be avoided in many situations in which they are currently used. The preferable alternative to tube feeding is hand feeding. Though it may not be effective in preventing malnutrition and dehydration, hand feeding allows the maintenance of patient comfort and intimate patient care. (Am Fam Physician 2002;65:1605-10. Copyright© 2002 American Academy of Family Physicians.) Feeding Tubes in Patients with Severe Dementia

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تاریخ انتشار 2002