Tuesday, April 22, 2014

NO, NO, Don't make us think about that!

Yes, we've all decided not to get old.  We're never going to get dementia.  And we won't think about it. Let's take a minute out from that stand.

A week or two ago, I commented on a Modern Healthcare blog:   

Feeding tube use in advanced dementia patients depends on provider, despite guidelines.  

Then I found an abstracted article in Health Affairs:  Type Of Attending Physician Influenced Feeding Tube Insertions For Hospitalized Elderly People With Severe Dementia 


 "This occurs despite the harms of the procedure, which may outweigh its benefits, and the procedure’s inconsistency with care focused on the patient’s comfort."

 We need a famous actor to go through this as a person with dementia who doesn't know where he is or what is being done to him.   
 Yes, things are done in hospitals every day that shouldn't be done.

But with dementia, there's all the difference in the world!  Because most people with dementia are not going to have enough clear moments to call a lawyer.  And with that thing down their throats, and with those restraints, they can't call anybody.  

Did the patient's surrogate sign informed consent for this?  I say, make the surrogate stay in the room to see what it's like.

Right now the whole thing seems to be in the hands of the doctor - with sub-specialists being likely to order this.   There are guidelines and the guidelines are ignored.

What's the answer?   Very slow feeding of very small bites has been suggested for the many patients with limited ability to swallow.

Will we ignore this?  Who we gonna call?  Before it's our turn?

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