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• W2003144302 abstract "To the Editor: According to a recent systematic review, the prevalence of individuals with dementia among the elderly Japanese population ranges from 2.9% to 12.5% and has been rising gradually over the past few years.1 One study reported an increase from 5.8% for those aged 65 to 69 to 77.7% in those aged 95 to 99 in 3,394 participants, with Alzheimer's disease being the most frequent cause (67.4%), followed by vascular dementia (18.9%), dementia with Lewy body disease (4.6%), and mixed dementia (4.2%).2 End-stage dementia, such as Alzheimer's disease, is one of the leading causes of dysphagia. Percutaneous endoscopic gastrostomy (PEG), a method rarely used in elderly adults with degenerative dementia in Western countries, is common in Japan and is used regardless of individual preference. The purpose of this study was to clarify the preference for feeding methods of elderly adults if they develop swallowing difficulty due to end-stage Alzheimer's disease. Tosa town in Kochi Prefecture had a population of 4,311 in 2012, of whom 1,739 (40.3%) were aged 65 and older. A comprehensive geriatric assessment questionnaire was mailed to 1,615 elderly people (excluding 124 long-term institutionalized individuals) in 2012 with the support of Tosa health staff. The response rate was 60.8% (n = 982) with 587 participants (233 men, 354 women; mean age 76.7 ± 7.6) returning complete questionnaires and 395 with incomplete questionnaires being excluded. Illustrations of feeding methods, including PEG, nasal tube feeding, drip infusion through peripheral vein (DIV), and intravenous hyperalimentation (IVH) were shown to participants along with brief explanations (Figure 1), and participants were asked whether they had experienced any of these methods and whether they had seen these methods administered to their relatives or friends. With regard to participants' own experiences, DIV was the most frequently experienced method (48.4%), followed by IVH (2.2%) and nasal tube feeding (2.0%); none of the participants had experienced PEG. Participants had seen DIV (64.4%), PEG (19.3%), IVH (17.2%), and nasal tube feeding (34.2%) administered to their families or friends. With an option to choose oral intake only, participants were then asked, “If you cannot take meals orally because of end-stage Alzheimer's disease, which feeding method do you prefer?” As for the preferred method, 42.5% of the participants chose DIV, whereas other artificial feeding methods were chosen much less frequently (IVH, 5.1%; PEG, 4.7%; nasal feeding tube, 4.3%); 50.3% chose none of the four methods, responding that they prefer oral intake until the end. There is insufficient evidence to suggest that enteral tube feeding is beneficial in individuals with advanced dementia.3 How should a decision regarding feeding method be made for individuals with dysphagia due to dementia? Only 4% to 5% of participants chose artificial methods as a preferred method. The Japan Geriatrics Society has established guidelines for decision-making process regarding artificial hydration and nutrition (AHN)4 with the concept of advance care planning,5 which emphasizes the importance of evaluation of swallowing function before introducing AHN and mentions that withdrawal, as well as administration, should be considered while respecting the well-being of each individual; yet the guidelines have not been widely used in Japan, and mutual communication between family members while still in a healthy stage is vital to determine preference. It has been recommended that advance care planning be considered during a comprehensive geriatric assessment.6 To respect the best interest of individuals with dementia, advance care planning should be started early on. The authors wish to thank all participants in Tosa who participated in the survey. We are deeply indebted to Ms. Toshiko Nagao (Illustrator), Drs. Masayuki Ishine (Yasugi Clinic), Naomune Yamamoto (Aino Hospital), and Kuniaki Otsuka (Chronomics and Gerontology, Tokyo Women's Medical University) for their invaluable contributions to the study. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Taizo Wada receives research support from a Grant-in-Aid for Scientific Research (C) from the JSPS (24590607). Author Contributions: Wada: study concept, data analysis, writing the manuscript. Imai, Okumiya, Fukutomi, Ishimoto, Kimura, Chen, Sakamoto, Fujisawa, Matsubayashi: data collection. Sponsor's Role: None." @default.
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• W2003144302 date "2014-09-01" @default.
• W2003144302 modified "2023-10-01" @default.
• W2003144302 title "Preferred Feeding Methods for Dysphagia Due to End-Stage Dementia in Community-Dwelling Elderly People in Japan" @default.
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• W2003144302 doi "https://doi.org/10.1111/jgs.13009" @default.
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