title: Artificial nutrition in old patients dying of dementia.
abstract: OBJECTIVE
  The aim of the review is to show main and recent evidence on and tendencies about artificial nutrition in advanced dementia.
  
  
  RESULTS
  Several studies in the last decade had been performed to provide evidence that supports lack of benefits or improvements in many aspects about caring of the elderly with advanced dementia. In spite of the evidence, we find an increased number of patients still submitted to artificial nutrition. There is high prevalence of misperceptions and misbeliefs about artificial nutrition among healthcare professionals in this scenario. Hand feeding for these patients is offered as an alternative arrangement, which may be characterized as dilemma. The decision-making process in artificial nutrition is considered as a difficult, complex and distressful issue, which addresses new strategies for improvement.
  
  
  CONCLUSIONS
  Despite the lack of evidence of benefits, the use of artificial nutrition remains commonplace in advanced dementia. Patient's wishes and family values should be taken into account in the decision-making process, as well as legal and ethical issues. Communication skills and acknowledgment of recent evidence are essential in decision-making in order to achieve the patient's best interests. Educational strategies and randomized prospective studies concerned about dying patients with advanced dementia are required.
authors.affiliation: aInstituto do Câncer do Estado de São Paulo - 'Octávio Frias de Oliveira', Hospital das Clínicas, São Paulo, Brazil.
authors.forename: Katia E
authors.initials: KE
authors.lastname: Nakaema
authors.forename: Gustavo
authors.initials: G
authors.lastname: Cassefo
authors.forename: Toshio
authors.initials: T
authors.lastname: Chiba