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Tube feeding AND dementia

Pamela Sarkar, Alice Cole, Neil J Scolding, Claire M Rice
Background/Aims: With the notable exceptions of dementia, stroke, and motor neuron disease, relatively little is known about the safety and utility of percutaneous endoscopic gastrostomy (PEG) tube insertion in patients with neurodegenerative disease. We aimed to determine the safety and utility of PEG feeding in the context of neurodegenerative disease and to complete a literature review in order to identify whether particular factors need to be considered to improve safety and outcome...
October 13, 2016: Clinical Endoscopy
Ezekiel Wong Toh Yoon, Kaori Yoneda, Shinya Nakamura, Kazuki Nishihara
BACKGROUND AND STUDY AIMS: Percutaneous endoscopic gastrostomy (PEG) using the introducer technique is not only useful in patients with upper digestive tract stenosis but has been shown to reduce peristomal infection. In this study, we evaluated the safety and utility of a novel large-caliber introducer PEG kit (using 20 Fr size tube) compared with a push kit of similar size. PATIENTS AND METHODS: One hundred and thirty-six patients who received PEG at our hospital between January 2014 and December 2015 were retrospectively analyzed...
September 2016: Endoscopy International Open
Susan L Mitchell, Vincent Mor, Pedro L Gozalo, Joseph L Servadio, Joan M Teno
No abstract text is available yet for this article.
August 16, 2016: JAMA: the Journal of the American Medical Association
Ayman Abu R, Tawfik Khoury, Jonah Cohen, Shmuel Chen, Shaul Yaari, Saleh Daher, Ariel A Benson, Meir Mizrahi
BACKGROUND: Percutaneous endoscopic gastrostomy (PEG) tubes are commonly utilized as a method of enteral feeding in patients unable to obtain adequate oral nutrition. Although some studies have shown improved mortality in select populations, the safety and effectiveness of PEG insertion in patients with dementia compared with those with other neurological diseases or head and neck malignancy remains less well defined. OBJECTIVE: To evaluate the nutritional effectiveness, rate of rehospitalization, and risk of mortality among patients with dementia compared with patients with other neurological diseases or head and neck cancers who undergo PEG placement...
August 8, 2016: Journal of Clinical Gastroenterology
Giuseppe Bellelli, Alessandro Morandi, Simona G Di Santo, Andrea Mazzone, Antonio Cherubini, Enrico Mossello, Mario Bo, Angelo Bianchetti, Renzo Rozzini, Ermellina Zanetti, Massimo Musicco, Alberto Ferrari, Nicola Ferrara, Marco Trabucchi
BACKGROUND: To date, delirium prevalence in adult acute hospital populations has been estimated generally from pooled findings of single-center studies and/or among specific patient populations. Furthermore, the number of participants in these studies has not exceeded a few hundred. To overcome these limitations, we have determined, in a multicenter study, the prevalence of delirium over a single day among a large population of patients admitted to acute and rehabilitation hospital wards in Italy...
2016: BMC Medicine
Karen Harrison Dening, Michael King, Louise Jones, Victoria Vickestaff, Elizabeth L Sampson
BACKGROUND AND AIMS: When a person with dementia (PWD) has lost the ability to make treatment decisions, clinicians often rely on family carers to know and articulate these preferences with assumed accuracy. This study used the Life Support Preferences Questionnaire (LSPQ) to explore whether family carers' choices show agreement with the end of life care preferences of the person with dementia for whom they care and what factors influence this. METHODS: A cross-sectional study interviewing 60 dyads (a person with early dementia and preserved capacity and their family carer) each completing a modified LSPQ...
2016: PloS One
J Diehl-Schmid, S Richard-Devantoy, T Grimmer, H Förstl, R Jox
OBJECTIVE: The aim of the present study was to gain insight into the living and care situation in advanced behavioral variant frontotemporal dementia (bvFTD), to describe symptoms and findings in advanced bvFTD, and to evaluate somatic comorbidities and circumstances of death. METHODS: Standardized interviews were conducted with family caregivers of 83 patients with bvFTD. Forty-four percent of the patients were already deceased at the time of the interview. RESULTS: At the time of the interview or death, respectively, 47% of the patients lived in a nursing home...
July 4, 2016: International Journal of Geriatric Psychiatry
Emma Somers, Carl Grey, Valerie Satkoske
PURPOSE OF REVIEW: This article explores various cultural perspectives of withholding and withdrawing of life-sustaining treatment utilizing a case involving artificial nutrition and hydration (ANH) to guide ethical discussion. RECENT FINDINGS: In the United States, there is a general consensus in the medical, ethical, and legal communities that the withholding and withdrawing of life-sustaining treatment are morally equivalent at the end of life. Despite this consensus, the withdrawal of treatment is still emotionally difficult, particularly with ANH...
September 2016: Current Opinion in Supportive and Palliative Care
Chidinma Chima-Melton, Terrence E Murphy, Katy L B Araujo, Margaret A Pisani
BACKGROUND: African-Americans and Hispanics receive disproportionately less aggressive non-critical treatment for chronic diseases than their Caucasian counterparts. However, when it comes to end-of-life care, minority races are purportedly treated more aggressively in Medical Intensive Care Units (MICU) and are more likely to die there. OBJECTIVE: We sought to determine the impact of race on the intensity of care provided to older adults in the Medical Intensive Care Unit (MICU) using the Therapeutic Intervention Scoring System-28 (TISS-28) and other MICU interventions...
June 2016: Journal of Racial and Ethnic Health Disparities
Theocharis Stavroulakis, Christopher J McDermott
Malnutrition and weight loss, due to suboptimal oral intake, are common in patients with neurological disorders and are associated with increased morbidity, disability and mortality. The nutritional management of neurological patients is crucial, and enteral feeding is commonly used to provide nutritional support. This review presents the different methods of enteral tube feeding and discusses its practice and efficacy in terms of clinical outcomes in the context of motor neurone disease, Parkinson's disease, Alzheimer's disease and other dementias, and stroke...
October 2016: Practical Neurology
Ruchika Mishra
KS is a 76-year-old Burmese woman who presented to the hospital with right-sided weakness that had begun two days prior. Although KS had been diagnosed earlier with dementia and had a medical history of stroke, she was living at a nursing home and was able to walk on her own and use her right arm to feed herself. Since her last stroke three years ago, she had also developed aphasia, and her speech has been minimal. During her current hospitalization, KS was found to have a cerebral hemorrhage, but after consultation with neurosurgery, the team determined that no medical interventions were available, and a higher level of care was not required...
April 2016: Cambridge Quarterly of Healthcare Ethics: CQ: the International Journal of Healthcare Ethics Committees
Bettina Schoene-Seifert, Anna Lena Uerpmann, Joachim Gerß, David Herr
OBJECTIVES: Whether health care professionals should respect a properly executed advance directive (AD) refusing life support in late-stage dementia even if the patient seems contented, is an ethically contested issue. We undertook a nationwide survey to assess this problem and to test a practical solution. DESIGN: Nationwide survey using a questionnaire among 4 stakeholder groups. SETTING: Germany. PARTICIPANTS: Adult Germans (n = 735), among them: dementia-experienced physicians (n = 161), dementia-experienced nurses (n = 191), next of kin (n = 197), and dementia-inexperienced adults (n = 186)...
April 1, 2016: Journal of the American Medical Directors Association
Rita Barosa, Carla Santos, Jorge Fonseca
Dear Editor, A 75-year-old woman living in a nursing home presented with a 24-hour history of abdominal cramping and vomiting. Medical history was remarkable for dementia and a percutaneous endoscopic gastrostomy (PEG) was performed 3 years earlier. The day before the admission the feeding tube was accidentally pulled out and a Foley catheter was placed in order to avoid stoma closure. On physical examination, there was extravasation of the gastric content through the stoma. The base of the "Y" of the Foley catheter was introduced in the gastric stoma and a pulling sensation was felt when it was mobilized...
January 2016: Revista Española de Enfermedades Digestivas
Rita Barosa, Carla Santos, Jorge Fonseca
Dear Editor, A 75-year-old woman living in a nursing home presented with a 24-hour history of abdominal cramping and vomiting. Medical history was remarkable for dementia and a percutaneous endoscopic gastrostomy (PEG) was performed 3 years earlier. The day before the admission the feeding tube was accidentally pulled out and a Foley catheter was placed in order to avoid stoma closure. On physical examination, there was extravasation of the gastric content through the stoma. The base of the "Y" of the Foley catheter was introduced in the gastric stoma and a pulling sensation was felt when it was mobilized...
November 23, 2015: Revista Española de Enfermedades Digestivas
Katja Kuehlmeyer, Anna F Schuler, Christian Kolb, Gian Domenico Borasio, Ralf J Jox
OBJECTIVES: To determine how nursing staff evaluate nonverbal behavior related to hand and tube feeding of residents with dementia. DESIGN: Cross-sectional survey. SETTING: A stratified sample of nurses and nursing assistants in residential nursing homes in a major German city. PARTICIPANTS: Nursing staff members (N = 131) in 12 nursing homes. MEASUREMENTS: Nursing staff perception of nonverbal behavior of residents with dementia in response to hand and tube feeding...
November 14, 2015: Journal of the American Geriatrics Society
Chia-Fen Tsai, Yao-Tung Lee, Wei-Ju Lee, Jen-Ping Hwang, Shuu-Jiun Wang, Jong-Ling Fuh
BACKGROUND: Family caregivers may not agree with patients with dementia regarding attitudes toward end-of-life preferences, and the effects of this type of disagreement are not well understood. This study sought to identify such a disagreement and its predictors. METHODS: A cross-sectional sample of 84 family caregivers and patients with dementia was recruited from memory clinics. We used the Mini-Mental State Examination, Neuropsychiatric Inventory, Clinical Dementia Rating, and Katz index of independence in activities of daily living to assess patient symptoms, functions, and severity of dementia...
2015: PloS One
Susan L Mitchell
New England Journal of Medicine, Volume 372, Issue 26, Page 2533-2540, June 2015.
June 25, 2015: New England Journal of Medicine
Jana Schulze, Rosa Mazzola, Falk Hoffmann
BACKGROUND: Tube feeding is a common form of long-term nutritional support, especially for nursing home residents, of whom many have dementia. OBJECTIVE: Estimating the incidence of feeding tube placement in nursing home residents with and without dementia. METHODS: Using claims data, we studied a cohort of newly admitted nursing home residents aged 65 years and older between 2004 and 2009. Analyses were stratified by dementia. We estimated incidence rates and performed multivariate Cox regression analyses...
February 2016: American Journal of Alzheimer's Disease and Other Dementias
Lee Andrew Kissane, Baku Ikeda, Reiko Akizuki, Shoko Nozaki, Kimio Yoshimura, Naoki Ikegami
PURPOSE: To determine under different End-of-Life (EoL) scenarios the preferences of the general public for EoL care setting and Life-sustaining-Treatments (LST), and to develop a new framework to assess these preferences. METHOD: Using a 2-stage, geographical cluster sampling method, we conducted a postal survey across Japan of 2000 adults, aged 20+. Four EoL scenarios were used: cancer, cardiac failure, dementia and persistent vegetative state (PVS). RESULTS: We received 969 valid responses (response rate 48...
November 2015: Health Policy
Pedro Gozalo, Michael Plotzke, Vincent Mor, Susan C Miller, Joan M Teno
BACKGROUND: Nursing home residents' use of hospice has substantially increased. Whether this increase in hospice use reduces end-of-life expenditures is unknown. METHODS: The expansion of hospice between 2004 and 2009 created a natural experiment, allowing us to conduct a difference-in-differences matched analysis to examine changes in Medicare expenditures in the last year of life that were associated with this expansion. We also assessed intensive care unit (ICU) use in the last 30 days of life and, for patients with advanced dementia, feeding-tube use and hospital transfers within the last 90 days of life...
May 7, 2015: New England Journal of Medicine
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