Starting artificial nutrition and hydration in patients with dementia in the Netherlands: frequencies, patient characteristics and decision-making process

Background and aims: In many patients with dementia, the oral intake of fluids and nutrients becomes insufficient and a decision has to be made whether to start artificial nutrition or hydration (ANH). This study examines the incidence of ANH in nursing-home patients with dementia in the Netherlands, the methods of administration used, patient characteristics, and the characteristics of the ANH decision-making process. Methods: In June 2001, a postal questionnaire was sent to all nursing-home physicians (NHPs) (n=1054) in the Netherlands. The response rate was 77%. Results: Of the NHPs, 39% had started ANH during the 1-year study period, mostly by hypodermoclysis. As calculated from the total number of patients in the Netherlands, the incidence density for ANH in demented nursing-home patients was 3.4 per 100 patient-years. The most important considerations in taking this decision were the patient’s physical condition, the expected result of rehydration, and the (presumed) wishes of the patient. Decisions to start hydration resembled decisions to start nutrition, but more frequently concerned incompetent patients with an intercurrent infectious disease. Conclusions: Compared with the USA literature, ANH is practised less in the Netherlands. This practice conforms to the prevailing treatment policy endorsed by the Dutch Association of Nursing-Home Physicians. In starting nutrition and/or hydration, an agreement about the (limited) duration of ANH is generally made, and the NHPs generally involve relatives and nurses in the decision-making process. Almost always, all parties involved agreed with decisions taken.