Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study

ObjectiveTo clarify the practice of withholding the artificial administration of fluids and food from elderly patients with dementia in nursing homes.DesignQualitative, ethnographic study in two phases.Setting10 wards in two nursing homes in the Netherlands.Participants35 patients with dementia, eight doctors, 43 nurses, and 32 families.ResultsThe clinical course of dementia was considered normal and was rarely reason to begin the artificial administration of fluids and food in advanced disease. Fluids and food seemed to be given mainly when there was an acute illness or a condition that needed medical treatment and which required hydration to be effective. The medical condition of the patient, the wishes of the family, and the interpretations of the patients'' quality of life by their care providers were considered more important than living wills and policy agreements.ConclusionsDoctors'' decisions about withholding the artificial administration of fluids and food from elderly patients with dementia are influenced more by the clinical course of the illness, the presumed quality of life of the patient, and the patient''s medical condition than they are by advanced planning of care. In an attempt to understand the wishes of the patient doctors try to create the broadest possible basis for the decision making process and its outcome, mainly by involving the family.

What is already known on this topic

Debate has focused on whether it is beneficial to withhold the artificial administration of fluids and food from patients with advanced dementia

What this study adds

The course of dementia, the patient''s quality of life, and the patient''s current medical condition influence doctors'' decision making more than advanced planning of careDoctors try to create the broadest possible basis for the decision making process and its outcome, mainly by involving the family     

长江三峡地区上震旦统稳定同位素异常及地层意义

三峡地区广泛发育的上震旦统,及下伏的南沱组和古城组冰碛层,有良好的生物地层控制及全球对比意义。新秭归城附近的雾河剖面,自南沱组顶部到水井沱组下部出露有利于化学地层学研究的一系列碳酸盐岩沉积,对这一剖面的碳,氧,锶同位素研究发现：1）碳,锶和氧同位素在陡山沱组顶部到灯影组底部存在明显异常;2）碳同位素在寒武系-前寒武系界线附近有负异常;3）碳同位素和锶同位素在剖面上的演化具有全球对比意义;4）陡山沱组顶部到灯影组底部的碳,锶同位素异常,与可能存在末远古纪的冰期,即所谓的“后Marinoan冰期”有关。