title: Withholding the artificial administration of fluids and food from elderly patients with dementia: ethnographic study.
abstract: OBJECTIVE
  To clarify the practice of withholding the artificial administration of fluids and food from elderly patients with dementia in nursing homes.
  
  
  METHODS
  Qualitative, ethnographic study in two phases.
  
  
  METHODS
  10 wards in two nursing homes in the Netherlands.
  
  
  METHODS
  35 patients with dementia, eight doctors, 43 nurses, and 32 families.
  
  
  RESULTS
  The 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.
  
  
  CONCLUSIONS
  Doctors' 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.
authors.affiliation: Department of Social Medicine, Institute for Research in Extramural Medicine, Vrije University Medical Centre, 1081 BT, Amsterdam, Netherlands. am.the.emgo@med.vu.nl
authors.forename: Anne-Mei
authors.initials: AM
authors.lastname: The
authors.forename: Roeline
authors.initials: R
authors.lastname: Pasman
authors.forename: Bregje
authors.initials: B
authors.lastname: Onwuteaka-Philipsen
authors.forename: Miel
authors.initials: M
authors.lastname: Ribbe
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D003657:Decision Making; D003704:Dementia / Q000523:psychology / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods* / Q000523:psychology; D005066:Euthanasia, Passive; D005260:Female; D005440:Fluid Therapy / Q000379:methods* / Q000523:psychology; D006707:Homes for the Aged; D006801:Humans; D016224:Living Wills; D008297:Male; D016743:Mental Competency; D008875:Middle Aged; D009426:Netherlands; D009735:Nursing Homes; D010347:Patient Care Planning; D011368:Professional-Family Relations; D011788:Quality of Life; D028761:Withholding Treatment