Starting artificial nutrition and hydration in patients with dementia in the Netherlands: frequencies, patient characteristics and decision-making process.
Running head: Starting ANH in patients with dementia
Authors: P.T. van Wigcheren, MSc*, B.D. Onwuteaka-Philipsen, PhD*, H.R.W. Pasman, PhD*#, M.E. Ooms, MD, PhD#, M.W. Ribbe, MD, PhD#, G. van der Wal, MD, PhD*
* Department of Public and Occupational Health, Institute for Research in Extramural Medicine, VU University Medical Centre
# Department of Nursing Home Medicine, Institute for Research in Extramural Medicine, VU University Medical Centre
Keywords: Dementia, Artificial nutrition, Hypodermoclysis, Decision-making
Correspondence: P.T. van Wigcheren
Van der Boechorststraat 7
1081 BT Amsterdam
fax: +31 20 4448387
E-mail:
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 as to whether or not to start artificial nutrition or hydration (ANH). This study aims to investigate the incidence of ANH in nursing home patients with dementia in the Netherlands, the administration methods used, the 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. Most important considerations in taking this decision were the patient’s physical condition, the expected result of rehydration and the (presumed) wish 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 to the USA literature, it seems that ANH is practised less in the Netherlands. This
practice is conforming 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 was made, and the NHPs generally involved relatives and nurses in the decision-
making process. Almost always all parties involved agreed with the decision.