Prediction of 81 million dementia sufferers fuels the artificial nutrition and hydration debate

Artificial nutrition and hydration for patients with advanced dementia: perspectives from medical practitioners in the Netherlands and Australia

From Palliative Medicine

The incidence of dementia is growing and is expected to double every 20 years. A large proportion of people with dementia will eventually receive end-of-life care. Patients with advanced dementia commonly develop eating difficulties, decreased feelings of hunger and thirst are often part of the dementia process. Patients can become incompetent to make decisions. At this point physicians and families decide whether artificial nutrition or hydration (ANH) is likely to be beneficial for the patient.

This article examines the ongoing debate surrounding patient assessment and appropriate use of ANH, it investigates opinions of some Dutch and Australian doctors and finds In general, they are reluctant to start ANH. It seems that Dutch and Australian doctors use somewhat different care approaches for patients with advanced dementia. The study concludes that combining the Dutch comprehensive approach and the Australian analytic approach may serve the interest of patients and their families best.

Abstract

The appropriate use of artificial nutrition or hydration (ANH) for patients with advanced dementia continues to be a subject of debate. We investigated opinions of Dutch and Australian doctors about the use of ANH in patients with advanced dementia. We interviewed 15 Dutch doctors and 16 Australian doctors who care for patients with advanced dementia. We transcribed and analysed the interviews and held consensus meetings about the interpretation. We found that Dutch and Australian doctors use similar medical considerations when they decide about the use of ANH. In general, they are reluctant to start ANH. Disparities between the Dutch and Australian doctors are related to the process of decision-making: Dutch doctors seem to put more emphasis on a comprehensive assessment of the patient’s actual situation, whereas Australian doctors are more inclined to use scientific evidence and advance directives. Furthermore, Dutch doctors take the primary responsibility themselves whereas Australian general practitioners seem to be more inclined to leave the decision to the family. It seems that Dutch and Australian doctors use somewhat different care approaches for patients with advanced dementia. Combining the Dutch comprehensive approach and the Australian analytic approach may serve the interest of patients and their families best.


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Article details
Buiting, H., Clayton, J., Butow, P., van Delden, J., & van der Heide, A. (2010). Artificial nutrition and hydration for patients with advanced dementia: perspectives from medical practitioners in the Netherlands and Australia Palliative Medicine, 25 (1), 83-91 DOI: 10.1177/0269216310382589

     
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