American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statement
American Geriatrics Society Feeding Tubes in Advanced Dementia Position Statement
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DOI：
10.1111/jgs.12924
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发表时间：
2014-08-01
影响因子：
6.3
通讯作者：
Cegelka, Aimee
中科院分区：
文献类型：
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作者：
Cegelka, Aimee
当出现进食困难时，不建议患有晚期痴呆症的老年人使用喂食管。应小心地提供手喂养，因为手喂养已被证明与管饲一样好的死亡，吸入性肺炎，功能状态和舒适度的结果。此外，管饲与躁动、更多地使用物理和化学约束、由于管相关并发症导致的医疗保健使用以及新的压疮的发展相关。通过改变环境和创造以患者为中心的喂养方法来加强口服喂养的努力应该成为晚期痴呆老年人常规护理的一部分。管饲是一种医学治疗，个体的代理决策者可以根据预先指示，先前陈述的愿望或认为个体想要的东西拒绝或接受。在长期护理环境中照顾住院医师的医疗团队的所有成员都有责任了解个人先前表达的关于管饲的任何愿望（通过审查预先指示和代理护理人员），并将这些愿望纳入护理计划。医院、疗养院和其他护理机构应促进选择，支持共享和知情的决策，并荣誉关于管饲的偏好。他们不应该对个人或供应商施加义务或施加压力，以建立管饲。
When eating difficulties arise, feeding tubes are not recommended for older adults with advanced dementia. Careful hand feeding should be offered because hand feeding has been shown to be as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status, and comfort. Moreover, tube feeding is associated with agitation, greater use of physical and chemical restraints, healthcare use due to tube-related complications, and development of new pressure ulcers. Efforts to enhance oral feeding by altering the environment and creating patient-centered approaches to feeding should be part of usual care for older adults with advanced dementia. Tube feeding is a medical therapy that an individual's surrogate decision-maker can decline or accept in accordance with advance directives, previously stated wishes, or what it is thought the individual would want. It is the responsibility of all members of the healthcare team caring for residents in long-term care settings to understand any previously expressed wishes of the individuals (through review of advance directives and with surrogate caregivers) regarding tube feeding and to incorporate these wishes into the care plan. Institutions such as hospitals, nursing homes, and other care settings should promote choice, endorse shared and informed decision-making, and honor preferences regarding tube feeding. They should not impose obligations or exert pressure on individuals or providers to institute tube feeding.