Artificial Nutrition and Hydration at the End of Life

Heuberger, Roschelle

doi:10.1080/01639366.2010.521020

Cited by 27 publications

(18 citation statements)

References 170 publications

(147 reference statements)

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“…No significant literature backs up the idea of providing artificial nutrition and hydration to extend life, and it may in fact decrease quality of life in elderly patients close to death. 11 In our study, the majority support providing only oral intake as tolerated in the context of CMO patient.…”

Section: Discussionmentioning

confidence: 89%

Comfort Measures Only

Zanartu

Matti-Orozco

2012

Am J Hosp Palliat Care

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Despite how frequently we say "comfort measures only" (CMO) in the hospital setting, review of the medical literature yields poor representation and definition of the term. Through a survey in our hospital center, we aimed at understanding what doctors understand as CMO. A total of 176 physicians responded to the survey. We asked them about the moment in the patient care timeline when to use it and what degree of respiratory support, laboratory draws, antibiotic therapy, level of care, and code status should be a part of it. Disparities in responses were the norm, and common defining characteristics were the exception.

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Section: Discussionmentioning

confidence: 89%

Comfort Measures Only

Zanartu

Matti-Orozco

2012

Am J Hosp Palliat Care

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“…This has to be respected by the treating team as long as collective autonomy does not harm the patient's voluntary will. If information about the specific preferences cannot be obtained, a conservative approach is recommended [67,68].…”

Section: Commentarymentioning

confidence: 99%

ESPEN guideline on ethical aspects of artificial nutrition and hydration

et al. 2016

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The ESPEN Guideline on Ethical Aspects of Artificial Nutrition and Hydration is focused on the adult patient and provides a critical summary for physicians and caregivers. Special consideration is given to end of life issues and palliative medicine; to dementia and to specific situations like nursing care or the intensive care unit. The respect for autonomy is an important focus of the guideline as well as the careful wording to be used in the communication with patients and families. The other principles of Bioethics like beneficence, non-maleficence and justice are presented in the context of artificial nutrition and hydration. In this respect the withholding and withdrawing of artificial nutrition and/or hydration is discussed. Due to increasingly multicultural societies and the need for awareness of different values and beliefs an elaborated chapter is dedicated to cultural and religious issues and nutrition. Last but not least topics like voluntary refusal of nutrition and fluids, and forced feeding of competent persons (persons on hunger strike) is included in the guideline.

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“…Also, there is serious worry of possible needs to use physical restraints and sedative drugs to prevent patient from pulling out feeding tube due to dementia-related agitation and lack of cognition [50,64]. Studies have shown that nearly two-thirds of nursing home residents get agitated and pull their feeding tubes within the first two weeks of insertion [65]. Also, there is disconcertment that PEG-fed demented individuals are going to be deprived the pleasure of eating as well as the natural human interactions that come with oral feeding [64].…”

Section: Other Burdens and Complicationsmentioning

confidence: 99%

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

Ijaopo

2019

Journal of Aging Research

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Background. Dementia remains a growing concern for societies globally, particularly as people now live longer. About 90% of individuals with advanced dementia suffer from eating problems that lead to general health decline and ultimately impacts upon the physical, psychological, and economic wellbeing of the individuals, caregivers, and the wider society. Objective. To evaluate the burdens and perceived benefits of tube feeding in individuals with advanced dementia. Design. Narrative review. Methods. Computerized databases, including PubMed, Embase, Medline, CINAHL, PsycInfo, and Google Scholar were searched from 2000 to 2019 to identify research papers, originally written in or translated into English language, which investigated oral versus tube feeding outcome in individuals with advanced dementia. Results. Over 400 articles were retrieved. After quality assessment and careful review of the identified articles, only those that met the inclusion criteria were included for review. Conclusion. Tube feeding neither stops dementia disease progression nor prevents imminent death. Each decision for feeding tube placement in individuals with advanced dementia should be made on a case-by-case basis and involve a multidisciplinary team comprising experienced physicians, nurses, family surrogates, and the relevant allied health professionals. Careful considerations of the benefit-harm ratio should be discussed and checked with surrogate families if they would be consistent with the wishes of the demented person. Further research is required to establish whether tube feeding of individuals with advanced dementia provides more burdens than benefits or vice-versa and evaluate the impacts on quality of life and survival.

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Artificial Nutrition and Hydration at the End of Life

Cited by 27 publications

References 170 publications

Comfort Measures Only

Comfort Measures Only

ESPEN guideline on ethical aspects of artificial nutrition and hydration

Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

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