重度認知症者に対する経管栄養の是非に関して論じた2009年のThe Cochrane LibraryのReviewである。Enteral tube feeding for older people with advanced dementia (Review)
PLAIN LANGUAGE SUMMARY
There is insufficient evidence to suggest that enteral tube feeding is beneficial in patients with advanced dementia. Data are lacking on the adverse effects of this intervention
Patients with advanced dementia often develop dysphagia (difficulties swallowing). They also experience changes in appetite and apraxia (difficulty co-coordinating movements) and may have difficulties feeding themselves. Two methods of enteral tube feeding are commonly used: the administration of food and fluids via a nasogastric tube (a tube that is passed through the nose and into the stomach) or via a percutaneous endoscopic gastrostomy (PEG) where a feeding tube is inserted into the stomach and is accessed through a permanent incision in the abdominal wall. The decision to use artificial hydration and nutrition in someone with dementia is often emotive and complex. Relatives and carers may request the intervention because they are concerned that the patient may starve; clinicians may be aware of the risks but feel pressurised by institutional, societal or even legal directives to intervene. We found no conclusive evidence that enteral tube nutrition is effective in terms of prolonging survival, improving quality of life, or leading to better nourishment or decreasing the risk of pressure sores. It may actually increase the risk of developing pneumonia due to inhaling small quantities of the feed and even death. This area is difficult to research but better designed studies are required to provide more robust evidence.
最終的に検討された論文は、米国5、スペイン1、イスラエル1からのものである。医療制度の違いもあり、本レビューの結果をそのまま日本に当てはめることはできない。しかし、これだけ普及している医療技術にも関わらず、重度認知症者に対する経管栄養が、生存率延長、QOL向上、栄養改善、褥瘡リスク低下に関してエビデンスがないという結論には驚かされる。
