[Dysphagia] reflux and feeding tubes

[nando11504 at hotmail.com (nando poppy)]

why do they keep putting tubes into adv. alzheimers?  $$$$$$$$$$$$$.  For 
some reason we can not allow someone to die in this country, that we have to 
do whatever it takes to keep them alive.  it's a shame.  we can put an 
animal to sleep when it is in pain, but not a human when they state they 
want to die.


>From: "juliespeech" <speechhuffman@nc.rr.com>
>To: <dysphagia@b9.com>
>Subject: Re: [Dysphagia] reflux and feeding tubes
>Date: Wed, 15 Feb 2006 17:28:43 -0500
>
>Its so sad to me that we are universally not recognizing how inappropriate 
>it is to tube-feed an individual with advanced Alzheimer's.  It certainly 
>makes me want to make sure my living will, and that of my family's is ready 
>to go!  All the literature is so clear in this area-- why is it still 
>happening when these poor folks end up hospitalized...
>
>Additionally, we can't as dysphagia therapists treat any one without 
>knowing a great deal about the esophagus, what symptoms are consistent with 
>esophageal dysphagia, and what recommendations would be contraindicated for 
>a person with esophageal problems (how about meds in applesauce without any 
>fluids before or after in someone with a severe motility disorder??? 
>yikes). For anyone out there still wanting to say, "that's not my part of 
>the body... leave it to GI" a terrible disservice is being done.  No, we 
>don't treat esophageal problems, but we can educate, properly differentiate 
>oropharyngeal vs esophageal symptoms and make sure what we recommend is 
>appropriate in the least!
>
>By the way, here's what ASHA has to say about it in case you think the 
>above is out of our scope of practice for the SLP.  See--
>American Speech-Language-
>
>Hearing Association. (2004). Guidelines for Speechlanguage
>
>pathologists performing videofluoroscopic
>
>swallowing studies. ASHA Supplement 24, pp. 77â??92.
>
>
>Julie Huffman
>----- Original Message ----- From: <Drirenect@aol.com>
>To: <malindam@samhealth.org>; <dysphagia@b9.com>
>Sent: Wednesday, February 08, 2006 9:38 AM
>Subject: Re: [Dysphagia] reflux and feeding tubes
>
>
>It is unfortunate that many if not most of the difficulties associated with
>swallowing in the patient with advanced dementing illness are exacerbated 
>if
>not  caused by the use of anticholinergic, dopamine antagonist 
>antipsychotics.
>This  has been apparent for decades but only now getting more attention. 
>SLPs
>could  contribute significantly to the literature on the causes of death -
>among them  the malnutrition and dehydration that go along with decreased 
>intake
>of food as  a result of the side efects of these medications. The 
>contribution
>of these meds  to mortality is high:
>
>Dec. 2, 2005
>N Engl J Med. 2005;353:2335-2341 â?? Conventional antipsychotics are at  
>least
>as likely as atypical agents to increase the risk for death among elderly
>persons, and they should not replace atypical agents discontinued in 
>response to
>the U.S. Food and Drug Administration (FDA) warning, according to the 
>results
>of  a retrospective cohort study reported in the Dec. 1 issue of The New
>England  Journal of Medicine.
>"Recently, the FDA issued an advisory stating that atypical antipsychotic
>medications increase mortality among elderly patients," write Philip S. 
>Wang,
>MD, DrPH, from the Brigham and Women's Hospital, Harvard Medical School in
>Boston, Massachusetts, and colleagues. "However, the advisory did not apply 
>to
>conventional antipsychotic medications; the risk of death with these older
>agents is not known."
>This retrospective cohort study included 22,890 patients 65 years of age or
>older who had drug insurance benefits in Pennsylvania and who began 
>receiving
>a  conventional or atypical antipsychotic medication between 1994 and 2003.
>The  investigators used analyses of mortality rates and Cox 
>proportional-hazards
>models to compare the risk for death within 180 days, less than 40 days, 40
>to  79 days, and 80 to 180 days after starting therapy with an 
>antipsychotic
>drug.
>For all intervals studied, conventional antipsychotic medications were
>associated with a significantly higher adjusted risk for death than were 
>atypical
>antipsychotic medications (</=180 days: relative risk [RR], 1.37;  95%
>confidence interval [CI], 1.27 - 1.49; <40 days: RR, 1.56; 95% CI, 1.37 - 
>1.78; 40 -
>79 days: RR, 1.37; 95% CI, 1.19 - 1.59; and 80 - 180 days: RR, 1.27;  95% 
>CI,
>1.14 - 1.41). This increased risk for death persisted in all subgroups
>defined by the presence or absence of dementia or nursing home residency.
>The greatest increases in risk occurred soon after therapy was started and
>with higher dosages of conventional antipsychotic drugs. Increased risks 
>for
>conventional vs atypical antipsychotic medications persisted in 
>confirmatory
>analyses using propensity-score adjustment and instrumental-variable
>estimation.
>"If confirmed, these results suggest that conventional antipsychotic
>medications are at least as likely as atypical agents to increase the risk 
>of  death
>among elderly persons and that conventional drugs should not be used to
>replace atypical agents discontinued in response to the FDA warning," the 
>authors
>write. "To place this magnitude of risk in perspective, only cancer,
>congestive heart failure, and HIV infection conferred greater adjusted 
>risks in  our
>analyses."
>Study limitations include possible underestimation of mortality resulting
>from the use of conventional agents, study based on nonexperimental data, 
>lack
>of information on potential mechanisms through which conventional
>antipsychotic  medications might increase the risk for death in the short 
>term, and lack
>of  data on the causes of death.
>"Beyond arousing new concern about conventional agents, our data provide no
>guidance with regard to which pharmacologic or nonpharmacologic 
>interventions
>should be used to manage the many conditions and symptoms for which
>antipsychotic medications are used," the authors conclude. "Traditionally, 
>the
>benefits and risks of treatments in the elderly have simply been 
>extrapolated  from
>studies involving younger populations. As the recent FDA advisory and the
>results of this study show, such a practice can be misleading, given the 
>unique
>needs and susceptibilities of older persons."
>The National Institute of Mental Health and the Agency for Healthcare
>Research and Quality have disclosed that they supported this study.
>In an accompanying perspective, Wayne A. Ray, PhD, from the Vanderbilt
>University School of Medicine in Nashville, Tennessee, notes that the 
>relative
>efficacy and long-term safety, including effects on mortality, of many 
>widely
>used medications, are poorly understood. He discusses methodologic 
>limitations
>of various approaches designed to fill this information gap.
>"Randomized trials would provide the most reliable data; however, in the
>absence of material reform of the system for the approval of new drugs, 
>there is
>little incentive to conduct such trials," Dr. Ray writes. "Nonrandomized
>studies  can provide valuable information, as does the thoughtful study by 
>Wang
>and  colleagues. However, observational studies of overall mortality are
>particularly  susceptible to numerous biases and thus must be conducted 
>with extreme
>care."
>
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