Patients and family members in the inpatient or outpatient setting.
Provide information and guidance to be used in decision-making for patients and family members regarding hydration in advanced dementia patients or in patients nearing the end of life.
Dementia is characterized by a progressive, irreversible, and expected cognitive and physical decline. The leading causes of mortality in advanced dementia patients are infection and dysphagia (1). Generally, dysphagia increases slowly over time, however, there may be periods where fluid intake abruptly decreases or stops completely. The onset of abruptly decreased oral intake should cue providers and family to search for reversible causes such as painful swallowing, depression, acute medical illness or delirium. However, in many cases no reversible causes are identified. Family members may inquire about the possibility of artificial hydration. Artificial hydration (AH) is defined as providing liquids through non-oral routes, such as intravenous (IV), subcutaneous (SQ), or enteral or parental nutrition (2, 3). Open discussions with family members and patients regarding the risks and benefits of AH when nearing end of life are essential to patient care.
- Identify key points for discussion of risks and benefits of AH nearing the end of life.
- Improve provider’s comfort level with difficult discussions with patients and family members.
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