ABSTRACT
Outcomes, particularly survival, for home-care patients with neurologic impairments who receive artificial nutrition, such as home parenteral nutrition (HPN) or percutaneous endoscopic gastrostomy (PEG) feeding, remain unclear. The efficacy of tube feeding for life prolongation in elderly patients remains controversial. The aim of this study was to assess the survival of elderly patients with neurologic impairments after the start of HPN or PEG. We retrospectively evaluated 80 patients with neurologic impairments who had received home care before they died. They were divided into three groups according to feeding method: oral-intake group (n = 23), HPN group (n = 21) and PEG group (n = 36). The factors considered were: age; survival period after commencement of home care; swallowing function; serum albumin concentration; level of activities of daily living (ADL); and behavioral, cognitive and communication functions. Survival periods of the patients in the PEG (736 ± 765 days) and HPN (725 ± 616 days) groups were twice that of the self-feeding oral-intake group (399 ± 257 days) despite lower serum albumin concentration (for PEG patients), reduced swallowing function and cognitive function, and poorer levels of ADL at the start of home care. Almost all patients were incapable of deciding whether they should receive artificial nutrition due to dementia or poor comprehension. Physicians should provide clinical evidence to families before commencing PEG feeding or HPN and support their decisions to maintain the dignity of the patient.
Subject(s)
Enteral Nutrition/ethics , Home Care Services/ethics , Nervous System Diseases/therapy , Parenteral Nutrition, Home/ethics , Aged , Aged, 80 and over , Enteral Nutrition/methods , Feeding Methods/ethics , Female , Follow-Up Studies , Humans , Intubation, Gastrointestinal/ethics , Intubation, Gastrointestinal/methods , Male , Nervous System Diseases/diagnosis , Parenteral Nutrition, Home/methods , Retrospective Studies , Treatment OutcomeABSTRACT
Las situaciones que plantean problemas éticos en relación con la nutrición y la hidratación son muy frecuentes hoy día, principalmente a nivel hospitalario tanto en pacientes terminales como en otro tipo de pacientes que precisen de hidronutrición. En este artículo se pretende analizar las sencillas en sus fundamentos, a la luz de valores éticos ampliamente aceptados, para intentar enunciar un modo de actuación claro que ayude en su resolución a los clínicos que han de tomar estas difíciles decisiones. Las situaciones problema analizadas incluyen, entre otras, si la hidratación y la nutrición deben considerarse medidas terapéuticas o cuidados básicos, y si presentan iguales aspectos éticos la nutrición enteral y la parenteral (AU)
Conditions that pose ethical problems related to nutrition and hydration are very common now days, particularly within Hospitals among terminally ill patients and other patients who require nutrition and hydration. In this article we intend to analyze some circumstances, according to widely accepted ethical values, in order to outline a clear action model to help clinicians in making such difficult decisions. The problematic situations analyzed include: should hydration and nutrition be considered basic care or therapeutic measures?, and the ethical aspects of enteral versus parenteral nutrition (AU)
Subject(s)
Humans , Nutritional Support/ethics , Fluid Therapy/ethics , Decision Making/ethics , Basic Health Services , Bioethical Issues , Intubation, Gastrointestinal/ethics , Treatment Refusal/ethicsSubject(s)
Enteral Nutrition , Gastrostomy/methods , Intubation, Gastrointestinal , Malnutrition/prevention & control , Contraindications , Enteral Nutrition/adverse effects , Enteral Nutrition/ethics , Enteral Nutrition/methods , Gastrostomy/ethics , Hospitalization , Humans , Intubation, Gastrointestinal/adverse effects , Intubation, Gastrointestinal/ethics , Intubation, Gastrointestinal/methods , Patient Care Team , Patient Selection , Referral and ConsultationSubject(s)
Brain Stem Infarctions/therapy , Consensus , Coronary Artery Bypass/adverse effects , Decision Making/ethics , Ethics Consultation/standards , Personal Autonomy , Professional Competence , Third-Party Consent , Treatment Refusal , Advance Directives , Aged , Brain Stem Infarctions/etiology , Choice Behavior/ethics , Dissent and Disputes , Emotions , Enteral Nutrition/ethics , Ethical Analysis , Female , Humans , Intubation, Gastrointestinal/ethics , Persuasive Communication , Respiration, Artificial/ethics , Third-Party Consent/ethics , Tracheostomy/ethics , Treatment Refusal/ethics , United StatesABSTRACT
Percutaneous endoscopic gastrostomy (PEG) has evolved into a common low-risk procedure in current medical practice. Clinical evidence supporting the use of tube feedings in patients with advanced dementia is clearly lacking, yet PEG procedures continue to be performed in a large number of these cases. In fact, multiple studies have shown that feeding tubes seldom are effective in improving nutrition, maintaining skin integrity by increased protein intake, preventing aspiration pneumonia, minimizing suffering, improving functional status, or extending life. The decision-making process is complicated, however, and involves the clinician considering such issues as advance directives, ethical considerations, legal/financial concerns, emotional factors, cultural background, religious beliefs, and the need for a family meeting incorporating all of these principles.
