Abstract
An increasing proportion of older adults with Alzheimer's disease or other dementias are now surviving to more advanced stages of the illness. Advanced dementia is associated with feeding problems, including difficulty in swallowing and respiratory diseases. Patients become incompetent to make decisions. As a result, complex situations may arise in which physicians and families decide whether artificial nutrition and hydration (ANH) is likely to be beneficial for the patient. The objective of this paper is to present methods for evaluating the nutritional status of patients with severe dementia as well as measures for the treatment of nutritional disorders, the use of vitamin and mineral supplementation, and indications for ANH and pharmacological therapy.
Highlights
Dementia is one of the most common and most significant health problems in the elderly and is one of the main causes of disability in older age [1] A growing proportion of older adults with Alzheimer disease (AD) or other dementias are surviving to more advanced stages of the illness [2, 3].Much clinical attention and research effort has been directed towards early diagnosis and mild stages of dementia, and prodromal stages, formerly classified as mild cognitive impairment (MCI)
Researchers concluded that the use of ANH may lead to a high frequency of complications Most studies show that there are substantial risks in using ANH in these patients, and its use is discouraged it may not be effective in preventing malnutrition and dehydration, this type of feeding allows a degree of maintenance and patient comfort Not choosing ANH did not correlate with the level of discomfort of the patients
ANH not recommended in patients with advanced dementia
Summary
Dementia is one of the most common and most significant health problems in the elderly and is one of the main causes of disability in older age [1] A growing proportion of older adults with Alzheimer disease (AD) or other dementias are surviving to more advanced stages of the illness [2, 3]. Malnutrition (namely, undernutrition) contributes to the alteration of general health status, to the frequency and gravity of complications, especially infections, and to a faster loss of independence. These states of malnutrition can be prevented or at least improved if an early intervention strategy is set up, but management must be rapid and appropriate. Because surrogates and other loved ones agonize over the withholding and/or withdrawal of artificial nutrition, healthcare providers need to be ready to discuss the most current data regarding efficacy, complications, and the ethical and legal issues [18,19,20]
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