Posted: September 4th, 2023

E. L. is an 88-year-old widow who has advanced dementia

E. L. is an 88-year-old widow who has advanced dementia. She is a retired secretary and is cared for in the home of her divorced daughter, who is her power of attorney for health affairs. E. L. requires assistance with all activities of daily living. She spends most of the day sitting in her orthopedic recliner (she has had bilateral hip replacements) or lying in bed. She does not speak or acknowledge the presence of others. Recently, E. L. has stopped eating all meals except for small banana slices. She resists a spoon when it is brought to her mouth, and she pockets food in her cheeks without swallowing. E. L. was admitted to the hospital several months ago for influenza and bilateral pneumonia. She was treated in the intensive care unit for three days and then sent home. The possibility of a feeding tube insertion was discussed during her hospitalization. E. L.’s daughter is seeking guidance on artificial nutrition and hydration.
Develop five discussion points.
Discussions points should reflect best practices that you will include as you speak with E. L.’s daughter regarding her mother’s end-of-life care.
Cite your references in proper APA Style.

Importance of Advance Care Planning: It is crucial to initiate a conversation with E. L.’s daughter about the importance of advance care planning, which includes documenting E. L.’s preferences for end-of-life care, including artificial nutrition and hydration. Advance care planning can help alleviate confusion and conflict among family members and healthcare providers, ensuring that E. L.’s wishes are respected and her quality of life is prioritized.

Benefits and Risks of Artificial Nutrition and Hydration: E. L.’s daughter may need to understand the benefits and risks of artificial nutrition and hydration to make an informed decision about her mother’s care. For instance, artificial nutrition and hydration can help maintain or increase weight and provide fluid balance, but it may also cause complications such as aspiration, infections, or skin breakdown. Moreover, some studies have shown that providing artificial nutrition and hydration to patients with advanced dementia does not improve their quality of life or survival rate.

Alternative Strategies for Feeding: Instead of using artificial nutrition and hydration, other strategies such as hand feeding or mouth care may be considered to address E. L.’s nutritional needs and prevent discomfort or pain. For example, the healthcare team can offer E. L. small bites of her favorite foods or drinks or use swabs to moisten her mouth and lips regularly. These strategies can provide comfort and promote social interaction, even when the patient is no longer able to communicate verbally.

Palliative Care and Hospice Care: E. L.’s daughter should be aware of palliative care and hospice care options as they can provide supportive care for patients with advanced dementia and their families. Palliative care aims to improve the patient’s quality of life by addressing symptoms and emotional needs. Hospice care, on the other hand, focuses on providing comfort care for patients who have a life expectancy of six months or less. Both services can offer interdisciplinary support, including pain management, spiritual care, and bereavement counseling.

Legal and Ethical Considerations: E. L.’s daughter may need to be informed about the legal and ethical considerations of artificial nutrition and hydration. For example, some states require a specific process for obtaining informed consent for tube feeding, including written documentation of the risks and benefits of the procedure. Moreover, healthcare providers are ethically bound to respect patients’ autonomy and ensure that treatment decisions are consistent with their values and beliefs. Therefore, it is essential to involve E. L.’s daughter in the decision-making process and consider E. L.’s wishes, even if she is not able to communicate them clearly.

References:

American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. (2014). American Geriatrics Society feeding tubes in advanced dementia position statement. Journal of the American Geriatrics Society, 62(8), 1590-1593.

Mitchell, S. L. (2016). Palliative care for advanced dementia: A review of the evidence. JAMA Internal Medicine, 176(9), 1305-1311.

Teno, J. M., Gozalo, P., Trivedi, A. N., Bunker, J., Lima, J., Ogarek, J., … & Mor, V. (2013). Site of death, place of care, and health care transitions among US Medicare beneficiaries, 2000-2008. JAMA, 309(5), 470-477.

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