Dementia Japan33:137-144, 2019

End-of-life care for elderly with advanced Alzheimer's Disease:focusing on artificial hydration and nutrition

Kaoruko Aita

Uehiro Division, Center for Death and Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, The University of Tokyo

One of major issues concerning end-of-life care for elderly with advanced Alzheimer's disease is what to do when they can no longer eat even with assistance.　A number of physicians in Japan recognize that withholding artificial hydration and nutrition (AHN) from those people almost equates to starving them to death.　However, the truth is that withholding AHN from patients at the final stage of lives is far from making them starve to death;it is a form of palliative care.　This is because a reduction in respiratory tract secretions leads to a reduction in the risk of respiratory obstruction, which results in a reduction in the number of aspirations.　In addition, the resultant increase in β-endorphins and Ketone bodies has analgesic and sedative effects naturally, without an injection of morphine.
Currently, hospital staff often provide end-stage patients with peripheral intravenous drips.　However, the treatment is more about reducing the mental burden on the family and medical and nursing care personnel than about medical demand.　When an intravenous drip bottle is hung at the bedside, it soothes the emotions of the family and medical and nursing care personnel, who want to believe that they are doing “something” for the patient.

Address correspondence to Dr. Kaoruko Aita, Uehiro Division, Center for Death and Life Studies and Practical Ethics, Graduate School of Humanities and Sociology, The University of Tokyo (7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan)