https://doi.org/10.4081/mem.2008.281

Medically assisted nutrition and hydration in end-stage dementia: burdens and benefits of surgically-placed gastrostomy tubes

V. 57 N. 3 (2008)
Pubblicato: giugno 30, 2008
Nutrizione e idratazione medicalmente assistite, demenza terminale, tube gastrostomiche / Medically assisted nutrition and hydration, end-stage dementia, gastrostomy tubes
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Autori

Johanna Valiquette
jpv2111@columbia.edu
MA, BSN, Columbia University School of Nursing, Lenox Hill Hospital Bioethics Committee (Manhattan), New York, United States.
Le tube gastrostomiche posizionate chirurgicamente si sono rilevate essenziali nel trattamento di alcune patologie. Ciononostante, molti studi le ritengono di efficacia limitata, e significativamente gravose nei pazienti con demenza avanzata terminale. Gli studi dimenticano di mostrare i benefici attesi in termini di maggiore longevità, diminuzione delle possibilità di polmonite e miglioramento dell'integrità della pelle. Gli svantaggi comprendono il deterioramento nella percezione e nella funzione relativi alla ospedalizzazione, l'angoscia derivante dall'uso di limitazioni, la negazione di taluni comfort del paziente, bisogni sociali e spirituali, per lasciare il posto ai dispositivi relativi ai tubi che spesso mettono a rischio l'igiene. Nel seguito affrontiamo i seguenti punti: 1. una review della letteratura recente dei principali ricercatori statunitensi; 2. la distinzione da un punto di vista bioetico nell'uso delle tube gastrostomiche nel cosiddetto "stato vegetativo" e nella demenza terminale; 3. l'analisi dei vantaggi e degli svantaggi; 4. le raccomandazioni per le cure palliative e la nutrizione come vengono percepite da un punto di vista bioetico e le alternative incentrate sul paziente al posizionamento delle tube gastrostomiche per i pazienti con demenza avanzata terminale.
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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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Valiquette, J. (2008). Medically assisted nutrition and hydration in end-stage dementia: burdens and benefits of surgically-placed gastrostomy tubes. Medicina E Morale, 57(3). https://doi.org/10.4081/mem.2008.281

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