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Medically assisted nutrition and hydration in end-stage dementia: burdens and benefits of surgically-placed gastrostomy tubes
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Surgically-placed gastrostomy tubes are essential in managing some conditions. Yet, many studies indicate limited medical effectiveness, and significant burdens, in patients with advanced, end-stage dementia. Studies fail to show the expected benefits of greater longevity, decreased aspiration pneumonia or improved skin integrity. Burdens include deterioration in cognition and function related to hospitalization, distress from use of restraints, neglect of patient's comfort, social and spiritual needs in favor of tube-related tasks and frequent, excoriating hygiene. Here we present 1. a review of recent literature by leading researchers in the U.S.; 2. distinction between the bioethics of gastrostomy tubes in the so-called "vegetative state" and endstage dementia; 3. analysis of benefits and burdens; 4. recommendations for palliative care and spoon-feeding as bioethically sound and patient-centered alternatives to gastrostomy tube placement for patients with advanced, endstage dementia.
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