De Diana, Thomas Carol
Senior Lecturer Adult Nursing, Cardiff University, UK.
Staff Nurse, Community Specialist Nurse, Cardiff and Vale University Health Board, UK.
Int J Palliat Nurs. 2019 May 2;25(5):216-223. doi: 10.12968/ijpn.2019.25.5.216.
Nutritional problems often manifest during late-stage dementia, and some families may request to instigate artificial nutrition and hydration (ANH) therapies. In the US, an estimated one-third of nursing home patients with a severe cognitive impairment have artificial feeding tubes inserted. Fear that a relative could experience extreme hunger or thirst if they are not mechanically fed tends to be the main driver behind family's requests to implement artificial or enteral feeding methods. In contrast, artificial hydration is rarely given to older people with dementia in the UK and this practice of non-intervention tends to apply across all healthcare and hospice type environments.
This literature review aims to evaluate the evidence to support the use and non-use of ANH.
A literature review was undertaken to examine the evidence around ANH for patients with dementia to offer support to families or carers contemplating feeding choices.
This paper challenges the implementation of invasive ANH worldwide. It highlights how resorting to ANH does not necessarily lead to improvements in comfort, survival or wound healing. The risk of aspiration does not appear to significantly alter either.
营养问题常在痴呆晚期出现，一些家庭可能会要求实施人工营养与水化（ANH）治疗。在美国，估计有三分之一患有严重认知障碍的养老院患者会插入人工喂食管。担心亲属若不通过机械喂食会遭受极度饥饿或口渴，往往是家庭要求实施人工或肠内喂养方法的主要驱动因素。相比之下，在英国，很少给患有痴呆症的老年人进行人工水化，这种不干预做法往往适用于所有医疗保健和临终关怀类型的环境。
本综述旨在评估支持使用和不使用ANH的证据。
进行了一项文献综述，以研究关于痴呆患者ANH的证据，为考虑喂养选择的家庭或护理人员提供支持。
本文对在全球范围内实施侵入性ANH提出了质疑。它强调了采用ANH不一定会改善舒适度、生存率或伤口愈合情况。误吸风险似乎也没有显著改变。
