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Starting artificial nutrition and hydration in patients with dementia in the Netherlands: frequencies, patient characteristics and decision-making process

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Abstract

Background and aims: In many patients with dementia, the oral intake of fluids and nutrients becomes insufficient and a decision has to be made whether to start artificial nutrition or hydration (ANH). This study examines the incidence of ANH in nursing-home patients with dementia in the Netherlands, the methods of administration used, patient characteristics, and the characteristics of the ANH decision-making process. Methods: In June 2001, a postal questionnaire was sent to all nursing-home physicians (NHPs) (n=1054) in the Netherlands. The response rate was 77%. Results: Of the NHPs, 39% had started ANH during the 1-year study period, mostly by hypodermoclysis. As calculated from the total number of patients in the Netherlands, the incidence density for ANH in demented nursing-home patients was 3.4 per 100 patient-years. The most important considerations in taking this decision were the patient’s physical condition, the expected result of rehydration, and the (presumed) wishes of the patient. Decisions to start hydration resembled decisions to start nutrition, but more frequently concerned incompetent patients with an intercurrent infectious disease. Conclusions: Compared with the USA literature, ANH is practised less in the Netherlands. This practice conforms to the prevailing treatment policy endorsed by the Dutch Association of Nursing-Home Physicians. In starting nutrition and/or hydration, an agreement about the (limited) duration of ANH is generally made, and the NHPs generally involve relatives and nurses in the decision-making process. Almost always, all parties involved agreed with decisions taken.

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Authors and Affiliations

  1. Institute for Research in Extramural Medicine, Department of Public and Occupational Health, VU University Medical Centre, the Netherlands

    Petra T. van Wigcheren Msc, Bregje D. Onwuteaka-Philipsen, H. Roeline W. Pasman & Gerrit van der Wal

  2. Institute for Research in Extramural Medicine, Department of Nursing Home Medicine, VU University Medical Centre, Amsterdam, the Netherlands

    H. Roeline W. Pasman, Marcel E. Ooms & Miel W. Ribbe

Authors
  1. Petra T. van Wigcheren Msc
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  2. Bregje D. Onwuteaka-Philipsen
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  3. H. Roeline W. Pasman
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  4. Marcel E. Ooms
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  5. Miel W. Ribbe
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  6. Gerrit van der Wal
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Correspondence to Petra T. van Wigcheren Msc.

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van Wigcheren, P.T., Onwuteaka-Philipsen, B.D., Pasman, H.R.W. et al. Starting artificial nutrition and hydration in patients with dementia in the Netherlands: frequencies, patient characteristics and decision-making process. Aging Clin Exp Res 19, 26–33 (2007). https://doi.org/10.1007/BF03325207

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  • DOI: https://doi.org/10.1007/BF03325207

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