The feeding paradox in advanced dementia: a local perspective
The feeding paradox in advanced dementia: a local perspective
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DOI：
10.12809/hkmj166110
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发表时间：
2017-06-01
影响因子：
2.7
通讯作者：
Tse, C. Y.
中科院分区：
文献类型：
--
作者：
Luk, James K. H.;Chan, Felix H. W.;Tse, C. Y.
进食问题在患有晚期痴呆症的老年人中很常见。当进食困难出现时，通常会启动管状喂养，除非有有效的预先指示，拒绝肠内喂养。管饲法有许多陷阱和并发症。到目前为止，还没有证明在生存、营养或预防吸入性肺炎方面有好处。细心的人工喂养是晚期痴呆症患者管饲的替代方案。在香港，医院管理局已就小心人工喂饲订立明确的道德指引。尽管如此，如果老年晚期痴呆症患者不使用管饲，当地仍有许多实际问题。对医生、护士和卫生保健团队其他成员的培训对推广手工喂养至关重要。政府和医院管理局的政策支持、医护人员培训、公众教育，以及促进预先护理计划和预先指令，对于减少对晚期痴呆症患者对管饲的依赖至关重要。
Feeding problems are common in older people with advanced dementia. When eating difficulties arise tube feeding is often initiated, unless there is a valid advance directive that refuses enteral feeding. Tube feeding has many pitfalls and complications. To date, no benefits in terms of survival, nutrition, or prevention of aspiration pneumonia have been demonstrated. Careful hand feeding is an alternative to tube feeding with advanced dementia. In Hong Kong, the Hospital Authority has established clear ethical guidelines for careful hand feeding. Notwithstanding, there are many practical issues locally if tube feeding is not used in older patients with advanced dementia. Training of doctors, nurses, and other members of the health care team is vital to the promulgation of careful hand feeding. Support from the government and Hospital Authority policy, health care staff training, public education, and promotion of advance care planning and advance directive are essential to reduce the reliance on tube feeding in advanced dementia.