Arcand Marcel
Full Professor in the Department of Family Medicine at the University of Sherbrooke in Quebec, a care of the elderly physician at Institut universitaire de gériatrie de Sherbrooke, and a researcher at the Centre de recherche sur le vieillissement in Sherbrooke.
Can Fam Physician. 2015 Apr;61(4):337-41.
To answer frequently asked questions about management of end-stage pneumonia, poor nutritional intake, and dehydration in advanced dementia.
Ovid MEDLINE was searched for relevant articles published until February 2015. No level I studies were identified; most articles provided level III evidence. The symptom management suggestions are partially based on recent participation in a Delphi procedure to develop a guideline for optimal symptom relief for patients with pneumonia and dementia.
Feeding tubes are not recommended for patients with end-stage dementia. Comfort feeding by hand is preferable. Use of parenteral hydration might be helpful but can also contribute to discomfort at the end of life. Withholding or withdrawing artificial nutrition and hydration is generally not associated with manifestations of discomfort if mouth care is adequate. Because pneumonia usually causes considerable discomfort, clinicians should pay attention to symptom control. Sedation for agitation is often useful in patients with dementia in the terminal phase.
Symptomatic care is an appropriate option for end-stage manifestations of advanced dementia. The proposed symptom management guidelines are based on a literature review and expert consensus.
回答有关晚期痴呆终末期肺炎、营养摄入不足及脱水管理方面的常见问题。
检索了截至2015年2月发表的相关文章的Ovid MEDLINE数据库。未发现I级研究；大多数文章提供III级证据。症状管理建议部分基于近期参与的一项德尔菲程序，该程序旨在制定一项针对肺炎合并痴呆患者最佳症状缓解的指南。
不建议为晚期痴呆患者使用鼻饲管。手动舒适喂食更佳。胃肠外补液可能有帮助，但也可能在生命末期增加不适。如果口腔护理得当，停止或撤除人工营养及补液通常不会出现不适表现。由于肺炎通常会引起相当大的不适，临床医生应注意症状控制。对于晚期痴呆患者，使用镇静剂缓解躁动通常很有用。
对症护理是晚期痴呆终末期表现的合适选择。所提出的症状管理指南基于文献综述和专家共识。
