Pasman et al evaluated risk factors for apparent discomfort in a severely demented patient for whom nutrition and hydration support has been discontinued. The authors are from VU University Medical Center and Nursing Home Slotervaart in Amsterdam, the Netherlands.


Patient selection: severe dementia in a nursing home with inadequate self-initiated fluid and nutrition intake


Problems with artificial nutritional and hydration support:

(1) often uncomfortable for the patient

(2) associated with aspiration pneumonia

(3) may be correlated with pressure ulcerations

(4) may require the patient to be restrained

(5) may not result in prolonged survival


Risk factors for apparent discomfort in patients who did not receive artificial nutrition and hydration:

(1) awake (being asleep was associated with lower discomfort)

(2) dyspnea

(3) restlessness

(4) pain behaviors/manifestations

(5) signs of dehydration


The level of apparent discomfort was highest on the first day and decreased over time. Since the data is based on observation, could the observer be biased on the day that the decision was made to forgo care?)


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