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Editor's Correspondence
February 27, 2006

Recognizing Patient Discomfort When Forgoing Artificial Nutrition and Hydration in Severe Dementia

Arch Intern Med. 2006;166(4):472. doi:10.1001/archinte.166.4.472-a

We found the study by Pasman and colleagues,1 which evaluated discomfort in patients with severe dementia, in whom artificial nutrition and hydration (ANH) was forgone, to be problematic. The authors provide evidence, using the Discomfort Scale–Dementia of Alzheimer Type (DS-DAT), suggesting that withholding tube feeding in patients with end-stage dementia carries no undue burden of physical discomfort. However, the ability to recognize discomfort in such patients is very limited, and as such, raises serious question as to the validity of the findings.