TO FEED OR NOT TO FEED IN LATE-STAGE DEMENTIA

Introduction: Nowadays, the administration of artificial nutrition and hydration is used for life-sustaining of patients with dementia that have decreased oral intake and dysphagia. The nutritional support is important because of its social, psycho-spiritual and religious meaning. However, its use in patients in the late stages of dementia is controversial. Objective: To know the state of the art regarding the issues surrounding artificial nutrition and hydration in the care of patients with dementia in the late stages. Methods: Narrative review of the literature. Results: The decision to withhold or withdrawn artificial nutrition and hydration in late-stage dementia raises the ethical question if that should be considered a treatment or a basic human care. Sometimes it is believed that lack of food and fluids may lead to a painful death by starvation and dehydration. Families and informed caregivers usually think that lack of food and fluids may hasten death, which can lead to conflicts with healthcare teams. These cannot take apart patients, families and informal caregivers from the triad of caring, so they need to be informed, trained and involved in the decision-making process surrounding nutrition and hydration. Nowadays, competent patients may express their will to receive or refuse feeding through advanced directives. Discussion: The complexity of these clinical cases must address a multidisciplinary approach. Demystifying and monitoring the evolution of disease processes, the reduction of capacity and maintaining quality of life should guide medical, nursing and nutrition practice.