That sounds really scary unless you realize that our research and technology have extended the lives of people who would have died of different diseases, and safer roads and automobiles have prevented thousands of deaths. Dick Cheney and Bill Clinton for instance have both been saved several times of dying of a heart attack. All that means is you live long enough to die of something else. Deaths from heart disease, stroke, prostate and breast cancer all decreased between 2000 and 2006, but Alzheimer's (about 70% of dementia cases) was up 47% in the same time period. And I doubt that too many actually die from dementia, but from something related like pressure sores, kidney infections, or pneumonia from aspirating food.
The February 10 issue of JAMA has an article on using feeding tubes with nursing home residents with "advanced cognitive impairment" i.e., dementia [Hospital characteristics associated with feeding tube placement in nursing home residents with advanced cognitive impairment," vol 303, no.6, p.544-550]. Using feeding tubes in patients with advanced dementia does not improve survival. So why is it done and why do the rates vary from hospital to hospital? That's what this study was supposed to explain. I'm not sure I understood all the details, but I did see that only 5.8% of hospitalized nursing home residents had an order to forego artificial hydration and nutrition despite the fact most nursing home residents say they would rather die than live in dementia with a feeding tube. (I'm not referring to people like Terri Schiavo who didn't actually need a feeding tube and wasn't dying--she was inconvenient for a husband who had received a very large monetary settlement and had started another family.) Also, I didn't see a distinction between hydration and feeding in this article. (Dehydration is an extremely painful death.) Also, it appears that feeding tubes don't solve any of the problems like pneumonia or pressure sores, which actually are the cause of death. The research also demonstrated that practices vary widely among hospitals and that black and Hispanic nursing home residents were more likely to undergo a feeding tube insertion. So is that more aggressive care or a reflection of how indigent people are treated?
As the authors of this study comment, the results raise more questions than they answered. For instance, the rates decreased during the 8 year study. But one thing I know, conservatives unhappy with Obamacare shouldn't use reluctance to use feeding tubes or counseling about preferences as a sign of an attempt to dispatch the elderly. There doesn't seem to be any evidence that feeding tubes help those suffering the end stages of dementia.
Saturday, March 06, 2010
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4 comments:
Dementia is also the leading cause of Conservatism in the U.S.
I'm sure you believe you are clever. You might need a check up yourself; it might be starting with such delusions.
Dementia is a terminal disease.
As to your comment regarding Terri Schiavo, she was not able to eat without artificial nutrition and hydration though her family held out the hope that they could teach her how to swallow. You can hold onto your hatred of Michael Schiavo but the facts make the "good" and "bad" actors in Schiavo's death difficult to distinguish.
The problem with feeding and hydration tubes is that they are legally difficult to remove. This can cause problems for those who are in the area still undefined in our modern medical environment: death. Death once meant that the brain, the heart and breathing all ended, often at the same time. Now technology has allowed us to sustain one or two of these functions while the others die.
Until we define death in our modern era, these questions - who is dead, when can one remove ANH, does natural death still exist - our laws will struggle to define medical practice. Continuing the conversation is good.
Demonizing those with differing opinions is not productive.
Your last paragraph is sound and wise advice.
Why would you think I hated Terri's husband? Her feeding tube was not a necessity, except to hurry things up. Once placed, they are difficult to remove. She wasn't dead; wasn't even dying. She was starved and dehydrated at the end--and died a horrid, painful death. Calling anything about it a good, even the conversation, is a stretch.
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