[Clinical features and prognosis of terminally ill patients in a geriatric long-term care hospital with particular regard to the implications of artificial nutrition].
OBJECTIVE
To clarify the clinical features of terminally ill patients in our hospital and elucidate the implications of administering artificial nutrition.


METHODS
Between April 2004 and March 2005, we assessed 155 patients who died in Nishimaruyama Hospital--a geriatric long-term care facility in Sapporo. We analyzed their clinical backgrounds on admission, the clinical course up to the terminal stage of the illness, and the outcome of patients who received artificial nutrition.


RESULTS
In 95 patients, the main cause of the terminal illness was infection. The symptoms of these patients, such as cerebral infarction and cognitive dysfunction, deteriorated progressively, and eventually, eating became difficult. At this point, alternative methods for providing nutrition were discussed. For 60 patients (41 died of acute disease and 19, of advanced cancers), artificial nutrition was not considered. Artificial nutrition was administered to 63 patients; tube feeding was carried out in 30 patients. Because of repeated aspiration pneumonia, 14 of these 30 patients eventually underwent intravenous hyperalimentation (IVH). Thirty-three patients directly underwent IVH. Thirty-two patients did not undergo any feeding course. The mean survival times of the tube feeding and non-artificial nutrition groups were 827 and 60 days, respectively. The difference in the survival times was statistically significant.


CONCLUSIONS
The outcome of patients who were placed on tube feeding was good. This may be because we selected those patients considered most suitable for tube feeding or IVH. The criteria that were used to select an appropriate method for providing nutrition varied, although the patients in our hospital requested palliative care.
Miyagishi
Ryuji
R
Department of Neurology, Nishimaruyama Hospital.
Higashi
Takuya
T
Akaishi
Yasuhiro
Y
Arai
Masayoshi
M
Minemawari
Yoshimori
Y
D000368:Aged; D000369:Aged, 80 and over; D003680:Deglutition Disorders / Q000628:therapy*; D005260:Female; D006769:Hospitals, General; D006801:Humans; D008134:Long-Term Care; D008297:Male; D010289:Parenteral Nutrition, Total / Q000706:statistics & numerical data; D013727:Terminal Care / Q000379:methods*; D019452:Terminally Ill