Maslow K
United States Congress, Office of Technology Assessment, Biological Applications Program, Washington, DC.
JPEN J Parenter Enteral Nutr. 1988 Sep-Oct;12(5):425-32. doi: 10.1177/0148607188012005425.
A 1987 report by the US Office of Technology Assessment (OTA), Life-Sustaining Technologies and the Elderly discusses current utilization of tube feeding and total parenteral nutrition (TPN) for elderly people and the related issues of patient access to treatment, decision making practices, and quality of care. Factors that limit access for some elderly patients include negative attitudes of some health professionals about whether elderly people can benefit from tube feeding and TPN, lack of adequate nutritional standards for the elderly and lack of staff in some treatment settings who are trained and have enough time to assess nutritional status in elderly patients, and payment problems. Public controversy about life-sustaining technologies for elderly people now focuses on decisions about withholding or withdrawal of tube feeding, but debate about the legal and ethical issues involved in these decisions tends to obscure the relevant clinical considerations. Research issues and clinical practice concerns related to decision making and quality of care for elderly patients on tube feeding and TPN are discussed.
美国技术评估办公室（OTA）1987年的一份报告《维持生命的技术与老年人》讨论了老年人目前对管饲和全胃肠外营养（TPN）的使用情况，以及患者获得治疗的相关问题、决策实践和护理质量。限制部分老年患者获得治疗的因素包括：一些医护人员对老年人能否从管饲和TPN中获益持消极态度；缺乏针对老年人的适当营养标准；在一些治疗机构中，缺乏经过培训且有足够时间评估老年患者营养状况的工作人员；以及支付问题。目前，关于老年人维持生命技术的公众争议集中在是否停止或撤销管饲的决策上，但是围绕这些决策所涉及的法律和伦理问题的争论往往掩盖了相关的临床考量。文中还讨论了与老年患者管饲和TPN决策及护理质量相关的研究问题和临床实践问题。
