title: Starting artificial nutrition and hydration in patients with dementia in The Netherlands: frequencies, patient characteristics and decision-making process.
abstract: OBJECTIVE
  In many patients with dementia, the oral intake of fluids and nutrients becomes insufficient and a decision has to be made whether to start artificial nutrition or hydration (ANH). This study examines the incidence of ANH in nursing-home patients with dementia in The Netherlands, the methods of administration used, patient characteristics, and the characteristics of the ANH decision- making process.
  
  
  METHODS
  In June 2001, a postal questionnaire was sent to all nursing-home physicians (NHPs) (n=1054) in The Netherlands. The response rate was 77%.
  
  
  RESULTS
  Of the NHPs, 39% had started ANH during the 1-year study period, mostly by hypodermoclysis. As calculated from the total number of patients in The Netherlands, the incidence density for ANH in demented nursing-home patients was 3.4 per 100 patient-years. The most important considerations in taking this decision were the patient's physical condition, the expected result of rehydration, and the (presumed) wishes of the patient. Decisions to start hydration resembled decisions to start nutrition, but more frequently concerned incompetent patients with an intercurrent infectious disease.
  
  
  CONCLUSIONS
  Compared with the USA literature, ANH is practised less in The Netherlands. This practice conforms to the prevailing treatment policy endorsed by the Dutch Association of Nursing-Home Physicians. In starting nutrition and/or hydration, an agreement about the (limited) duration of ANH is generally made, and the NHPs generally involve relatives and nurses in the decision-making process. Almost always, all parties involved agreed with decisions taken.
authors.affiliation: Institute for Research in Extramural Medicine, Department of Public and Occupational Health, VU University Medical Centre, Amsterdam, The Netherlands. p.vanwigcheren@vumc.nl
authors.forename: Petra T
authors.initials: PT
authors.lastname: van Wigcheren
authors.forename: Bregje D
authors.initials: BD
authors.lastname: Onwuteaka-Philipsen
authors.forename: H Roeline W
authors.initials: HR
authors.lastname: Pasman
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Ooms
authors.forename: Miel W
authors.initials: MW
authors.lastname: Ribbe
authors.forename: Gerrit
authors.initials: G
authors.lastname: van der Wal
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003704:Dementia / Q000178:diet therapy* / Q000453:epidemiology*; D005260:Female; D005440:Fluid Therapy / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007239:Infections / Q000178:diet therapy / Q000453:epidemiology; D008297:Male; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes / Q000706:statistics & numerical data; D018529:Nutritional Support / Q000706:statistics & numerical data*; D011177:Postal Service; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000706:statistics & numerical data*