SURVEYING ELDERLY PATIENTS’ WISHES ABOUT ARTIFICIAL NUTRITION DURING END-OF-LIFE CARE IN JAPAN

Abstract

Because ambiguity is one of the prominent features of Japanese culture, it is crucial to understand how many Japanese elderly persons have strong wishes related to end-of-life care. Ninety-nine consecutive inpatients aged 75 years or older were enrolled in the first survey from 2012 to 2014, after excluding patients with a Mini-Mental State Examination (MMSE) score of 20 or less. The first survey was performed by interviewing them about their wishes related to artificial nutrition and hydration (ANH) during end-of-life care. For the 35 patients who had attended the first survey, we performed the second survey from 2015 to 2016 by handing them the questionnaire comprised of the same items as the first survey. 50.0% of the participants were against ANH at the end stage of their lives on the first survey. In contrast, only 5.3% wished to receive ANH. The answers of the other patients were inconsistent or included “I don’t know”. Aging and MMSE scores of less than 24 were significantly associated with a higher tendency to decline from participating in the interview. However, the distribution of the interview answers was not associated with age or MMSE scores. Interestingly, 87.5% of the patients who had been against ANH on the first survey selected the same answers on the second survey, while only 20.0% of the other patients selected the same answers as the first survey. In conclusion, many patients did not have definite wishes in Japan. However, most of the wishes against ANH did not change with age.