A point of view: nutrition and care of terminally ill patients

Article Abstract:

Technological advances have made it possible to maintain physiologic function long after the loss of higher brain function. These technologies have been used in cases where recovery of consciousness is extremely improbable, frequently due to uncertainty of outcome when treatment was begun or to lack of knowledge about the patient's own wishes. This is compounded by the natural respect for life and a well-intentioned desire to help, even when this becomes a desperate attempt to put off inevitable death. More respect should be given to the person of the patient, so that unnecessary suffering by patient and family may be avoided. These issues, which concern health and human dignity and the physician's duties to comfort the sick, cure where possible, do no harm, and respect the patient, have led to debate about what constitutes proper care of the terminally ill. Physicians are ultimately responsible for patient care, and all members of the health care team, as well as trainees in these fields, need to be educated with respect to a physician's duties. There are no simple formulas for decisions on care of the terminally ill, but a good place to start is placing the patient's wishes first, while meeting needs such as minimizing pain, comforting, and assisting with food, drink, and bodily functions. Discontinuing invasive or discomforting treatments should be done when recovery is very unlikely, and life - practically speaking - is at an end. Patients and families should make their wishes known before becoming ill and make a living will or, less effectively, discuss the issues with family and physician. Hospice organizations can also be helpful. Legal aspects of these issues vary from state to state, and knowledge of patient's wishes seems to be paramount in courts' decisions. Feeding by artificial means is not justified when the ability to communicate with family and others is lost, when participation in activities of daily living is lost, or when pain and suffering is unbearable. Above all, both family and physician should focus on the wishes and needs of the patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Terminally ill persons, Terminally ill, Ethical aspects, Artificial feeding, Feeding methods, editorial

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Nutrition status and brain function in aging

Article Abstract:

For elderly people, the maintenance of good mental function is an important aspect of overall health. However, little is known about the role of nutrition in the maintenance of cognitive function. To determine if there are correlations between nutritional indices and mental function in older persons, 28 healthy subjects over 60 years old were evaluated using neuropsychological tests and electroencephalography (EEG), recording of the electrical activity of the brain. Nutritional status was evaluated by testing the subjects' blood for 18 different indicators. It was found that performance on the more demanding of the neuropsychological tests was correlated with many of the nutritional parameters. In addition, EEG function was found to correlate with indices of thiamine, riboflavin, and iron. In particular, a decrease in alpha-wave activity was found among subjects with low thiamine indices, indicating that levels of nutrition which are well above true clinical deficits may nevertheless be associated with changes in brain function. However, it is important to recognize that the observations of this study cannot establish a cause-and-effect relationship. Although it is tempting to speculate that substandard nutrition may be responsible for minor deficits in mental function, it is also possible that the more alert and better functioning subjects are simply taking better care of themselves and providing themselves with better nutrition. (Consumer Summary produced by Reliance Medical Information, Inc.)

Psychological aspects, Aged, Elderly, Demographic aspects, Malnutrition, Geriatric neurology

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Adolescent pregnancy: associations among body weight, zinc nutriture, and pregnancy outcome

Article Abstract:

The amount of risk involved in teenage pregnancy has not been established, but studies have suggested that young mothers have an increased chance of premature delivery and low infant birth weight. Competition for nutrients between the mother's body, which is still growing, and the developing fetus can lead to infant growth retardation. Zinc is a particularly important nutrient because it is essential for growth of both the adolescent mother and the fetus. Teenage mothers may not meet their zinc needs because of unbalanced food choices, financial limitations, and disrupted home environments. Five-hundred fifty-six predominantly black, unmarried, low-income teenagers completed the study. Half the mothers received zinc supplements during pregnancy while the other half received an inert placebo. Zinc supplementation was linked to reduced prematurity and infant illness, and its effects were influenced by the mother's weight. In the zinc-supplemented group, babies of normal weight mothers had less need for artificial respiration equipment and babies of underweight mothers were carried an average of 2.8 weeks longer and weighed more, as compared with the unsupplemented group. While the additional zinc appeared beneficial in this population, it may not provide a similar advantage to mothers of higher economic status.

Usage, Complications and side effects, Infants (Premature), Birth weight, Low, Premature infants, Low birth weight, Teenage pregnancy, Dietary supplements, Zinc deficiency diseases

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