Cardin Fabrizio
Geriatric Surgery Unit, Geriatric Department, Padova University and General Hospital, Via Giustiniani 1, 35100 Padova, Italy.
ISRN Gastroenterol. 2012;2012:607149. doi: 10.5402/2012/607149. Epub 2012 Nov 25.
Undernutrition in frail elderly people is a pathological condition that needs to be recognized and addressed early. Neurological dysphagia is among the most frequent causes of this condition in the elderly but should be considered a terminal event in Alzheimer-type dementias. Tube feeding is an important resource for facilitating metabolic recovery in cachectic patients and is particularly successful in "bridging" and stabilizing therapies prior to major treatment able to cure the patient. Clinical management of tube feeding in "incurable" conditions is complex and becomes part of the palliative care and comfort provided in the terminal stages of illness. Non-specialized physicians are often unfamiliar with the theory and practice of end-of-life interventions, and the resulting decisions are in many cases actually contrary to patient comfort. These problems deserve to be more carefully addressed when the patient is unable to cooperate or express his/her preferences and needs. The success of percutaneous endoscopic gastrostomy has led to increasingly frequent referrals for placement in critically ill elderly patients. Endoscopists therefore become a key figure in stimulating rational, correct treatment of these patients.
体弱老年人的营养不良是一种需要尽早识别和处理的病理状况。神经源性吞咽困难是老年人出现这种状况的最常见原因之一，但在阿尔茨海默型痴呆症中应被视为终末期事件。管饲是促进恶病质患者代谢恢复的一项重要手段，在能够治愈患者的主要治疗之前的“过渡”和稳定治疗中尤其成功。在“无法治愈”的情况下，管饲的临床管理很复杂，成为疾病终末期姑息治疗和舒适护理的一部分。非专科医生往往不熟悉临终干预的理论和实践，在很多情况下，由此做出的决定实际上有悖于患者的舒适度。当患者无法配合或表达其偏好和需求时，这些问题值得更仔细地加以解决。经皮内镜下胃造口术的成功使得重症老年患者接受造口术的转诊越来越频繁。因此，内镜医师成为推动对这些患者进行合理、正确治疗的关键人物。
