Introduction: Psychogeriatric nursing home patients frequently develop difficulties in eating and drinking. At some point in many patients a desicion about whether or not to start artificially administration of nutrition or hydration (ANH) has to be made. In this study we were interested in the clinical course after starting ANH.
Methods: In a retrospective study, all Dutch nursing home physicians (NHPs) (n=1054), received a postal questionnaire. They were asked about the most recent patient in whom they had started ANH. The response rate was 77% (n=704). Of the responding NPHs 406 could describe a case of a patient in whom they had started ANH. 231 patients received fluids only (by hypodermoclyses or intravenous infusion) and 175 patients received food and fluids (by a nasal-gastric feeding tube or a PEG tube).
Results: About half of the patients were severely physically ill at the moment that the NHP decided to start ANH. In half of the patients the ANH was discontinued within three days, either because the patient did recover or because continuing was medical senseless. About one out of six patients did suffer from the ANH according to the NHP and in almost a quarter there appeared complications, such as extubation by the patient or aspiration pneumonia. These complications appeared more frequently in patients who were tube fed (34%), than in those who received fluids only (14%). Half of the patients were still alive after six weeks.
Conclusions: In half of the patients the ANH is only given for a few days and according to the NHP most patients hardly suffer from starting ANH. Complications more often appear in tube fed patients than in patients who received fluids, so fluids seems to burden the patient less.