Available online 26 November 2022
Author links open overlay panelAbstractDementia is an increasingly prevalent disease in our environment, with significant health and social repercussions. Despite the available scientific evidence, there is still controversy regarding the use of enteral tube nutrition in people with advanced dementia. This document aims to reflect on the key aspects of advanced dementia, tube nutritional therapy and related ethical considerations, as well as to respond to several frequent questions that arise in our daily clinical practice.
ResumenLa demencia es una enfermedad cada vez más prevalente en nuestro entorno, con importantes repercusiones sanitarias y sociales. Pese a la evidencia científica disponible, aún existe controversia sobre el empleo de la nutrición enteral por sonda en las personas con demencia avanzada. En el presente documento se pretende reflexionar sobre los aspectos clave de la demencia avanzada, el tratamiento nutricional por sonda y las consideraciones éticas relacionadas, así como dar respuesta a una serie de cuestiones frecuentes que se nos plantean en nuestra práctica clínica diaria.
IntroductionDementia is an increasing prevalent disease in Spanish society, with significant health and social repercussions. Despite current scientific evidence, the use of enteral tube feeding in patients with advanced dementia (AD) remains subject to much debate. The aim of this document is to consider the key aspects of AD, the use of nutritional therapy by tube in advanced dementia patients and the associated ethical considerations (the main or strong ideas are detailed in Fig. 1), as well as to answer a series of frequently-asked questions that arise in our daily clinical practice.
Section snippetsDementiaDementia, or major neurocognitive disorder, is an incurable and progressive disease that causes severe impairment of cognitive, verbal and functional capabilities and affects daily life.1
The clinical course of dementia is not the same for all patients. Median survival after the onset of symptoms ranges from three to 12 years, and between three and 6.6 years following diagnosis, with the majority of this time spent in the more advanced stages of the disease.2 AD corresponds to stage 7 of the
Enteral nutritionMedical nutrition therapy includes routes for oral, enteral and parenteral artificial feeding. Rather than just the basic provision of food and liquids, artificial hydration and nutrition are medical treatment and life support measures. Initiating treatment with artificial nutrition or hydration alone requires an indication for that medical treatment, a definition of the therapeutic goal to be achieved and the will or informed consent of the patient or their legal representatives. In all cases,
Ethical considerationsDeciding whether or not to initiate enteral tube feeding in patients with AD gives rise to a contentious situation, which can be understood with the following reflections.
What are the expected benefits of tube feeding for people with AD?The only benefits people with AD receiving enteral tube feeding may receive maintaining their body weight, alleviating dehydration and preventing these complications if administered in the early stages of malnutrition. Moreover, in a select group of patients, the stress caused by coughing and suffocation associated with oral intake could be reduced. At the same time, functional capacity for small activities of daily living may be maintained.22
However, it has not been shown that enteral tube
Ethical declarationsProtection of people and animals in research. The authors declare that no experiments were performed on humans or animals for this study.
Right to privacy and informed consent. The authors declare that patient data are not disclosed in this article.
Protection of patient data. The authors declare that patient data are not disclosed in this article.
Conflicts of interestThe authors declare that they have no conflicts of interest.
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