Somogyi-Zalud E, Likourezos A, Chichin E, Olson E
The Jewish Home and Hospital, 120 West, 106th Street, 10025, New York, NY, USA
Arch Gerontol Geriatr. 2001 Mar;32(2):101-111. doi: 10.1016/s0167-4943(01)00080-2.
In the nursing home, a widely accepted medical practice is to recommend the initiation of long term tube feeding in residents with eating difficulties. However, frequently the nursing home resident has dementia, lacks decision-making capacity, and has no advance directives to guide the physician and the family member(s). Therefore, the family member or another surrogate decision maker has to make the difficult decision of whether or not to consent to the placement of a feeding tube. We surveyed 50 English speaking surrogates of nursing home residents who were on a feeding tube for at least 6 months. Each surrogate was contacted by telephone and was administered a 16-item structured questionnaire. Statistical analyses included frequency distributions, and the Wilcoxon signed rank test for two related samples. Most surrogates rated the residents' quality of life as poor or extremely poor. Yet, 78% of the surrogates perceived tube feeding to be beneficial, 62% would repeat their initial decision to initiate tube feeding, and 68% would not consider removal of the feeding tube. Their leading concerns were medical complications, tube feeding's impact on each resident's quality of life, and adequacy of nursing care. The surrogates were satisfied with their initial decision for the placement of a feeding tube despite their perception that there was no improvement in the quality of life of the residents. The surrogates may have viewed tube feeding as a life prolonging measure.
在养老院，一种广泛接受的医疗做法是建议对有进食困难的居民开始长期管饲。然而，养老院居民常常患有痴呆症，缺乏决策能力，也没有预先指示来指导医生和家庭成员。因此，家庭成员或其他替代决策者必须做出是否同意放置饲管的艰难决定。我们调查了50名养老院居民的说英语的替代决策者，这些居民接受饲管至少6个月。通过电话联系每位替代决策者，并对其进行一份包含16个条目的结构化问卷调查。统计分析包括频率分布，以及针对两个相关样本的威尔科克森符号秩检验。大多数替代决策者将居民的生活质量评为差或极差。然而，78%的替代决策者认为管饲有益，62%的人会重复他们最初开始管饲的决定，68%的人不会考虑拔除饲管。他们最主要的担忧是医疗并发症、管饲对每位居民生活质量的影响以及护理的充分性。尽管替代决策者认为居民的生活质量没有改善，但他们对最初放置饲管的决定感到满意。替代决策者可能将管饲视为一种延长生命的措施。
