Logo of jnnpsycJournal of Neurology, Neurosurgery and PsychiatryVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
J Neurol Neurosurg Psychiatry. 2005 Oct; 76(10): 1420–1424.
PMCID: PMC1739352

Prevalence and characteristics of patients in a vegetative state in Dutch nursing homes


Objectives: To establish the prevalence of vegetative state in Dutch nursing homes, describe the patient characteristics, and highlight the possible influence of medical decisions at the end of life.

Design: A cross-sectional survey. The vegetative state was defined according to the Multi Society Task Force on PVS. All Dutch nursing homes were approached to provide data on patients in a vegetative state. In cases of doubt, the researcher discussed the diagnosis with the patient's physician and, if necessary, examined the patient. Information on patients in a vegetative state in care between 2000 and September 2003 and end of life decisions for them were also recorded.

Results: All nursing homes and physicians participated. After assessment of 12 doubtful patients, 32 met the criteria of vegetative state lasting longer than one month, a prevalence of 2/1 000 000. Of these, 30 patients' data were analysed: age 9–90 years; 73% female; duration of vegetative state 2 months–20 years (26 surviving >1 year, 13 >5 years). Stroke was the commonest cause. Between 2000 and September 2003, there were 76 patients in a vegetative state in care of whom 34 died of complications and nine after withdrawal of artificial nutrition and hydration.

Conclusions: The prevalence of vegetative state in Dutch nursing homes has been established for the first time. The figures are lower than suggested in the literature. The study included a heterogeneous group of patients, of which a substantial number survived for many years. The results cannot be explained by a policy of systematically withdrawing artificial nutrition and hydration.

Full Text

The Full Text of this article is available as a PDF (74K).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Jennett B, Plum F. Persistent vegetative state after brain damage. A syndrome in search of a name. Lancet. 1972 Apr 1;1(7753):734–737. [PubMed]
  • Andrews K. International Working Party on the Management of the Vegetative State: summary report. Brain Inj. 1996 Nov;10(11):797–806. [PubMed]
  • Lavrijsen Jan, van den Bosch Hans, Koopmans Raymond, van Weel Chris, Froeling Paul. Events and decision-making in the long-term care of Dutch nursing home patients in a vegetative state. Brain Inj. 2005 Jan;19(1):67–75. [PubMed]
  • Charatan Fred. Governor Jeb Bush intervenes in "right to die" case. BMJ. 2003 Oct 25;327(7421):949–949. [PMC free article] [PubMed]
  • Minderhoud JM, Braakman R. Het vegeterende bestaan. Ned Tijdschr Geneeskd. 1985 Dec 14;129(50):2385–2388. [PubMed]
  • Stepan Ch, Haidinger G, Binder H. Prevalence of persistent vegetative state/apallic syndrome in Vienna. Eur J Neurol. 2004 Jul;11(7):461–466. [PubMed]
  • Higashi K, Sakata Y, Hatano M, Abiko S, Ihara K, Katayama S, Wakuta Y, Okamura T, Ueda H, Zenke M, et al. Epidemiological studies on patients with a persistent vegetative state. J Neurol Neurosurg Psychiatry. 1977 Sep;40(9):876–885. [PMC free article] [PubMed]
  • Tresch DD, Sims FH, Duthie EH, Goldstein MD, Lane PS. Clinical characteristics of patients in the persistent vegetative state. Arch Intern Med. 1991 May;151(5):930–932. [PubMed]
  • Hoek JF, Penninx BW, Ligthart GJ, Ribbe MW. Health care for older persons, a country profile: The Netherlands. J Am Geriatr Soc. 2000 Feb;48(2):214–217. [PubMed]
  • Hoek JF, Ribbe MW, Hertogh CM, van der Vleuten CP. The specialist training program for nursing home physicians: a new professional challenge. J Am Med Dir Assoc. 2001 Nov-Dec;2(6):326–330. [PubMed]
  • Lavrijsen JCM, van den Bosch JSG, Costongs LGP, Eilander HJ, Hoenderdaal PL, Minderhoud JM. Diagnostiek van vegetatieve toestand als basis voor medisch handelen op de grens van leven en dood. Ned Tijdschr Geneeskd. 2003 Feb 1;147(5):195–198. [PubMed]
  • Lavrijsen JC, van den Bosch JS. Medisch handelen bij patiënten in een chronisch coma; een bijdrage uit de verpleeghuisgeneeskunde. Ned Tijdschr Geneeskd. 1990 Aug 11;134(32):1529–1532. [PubMed]
  • Volicer L, Berman SA, Cipolloni PB, Mandell A. Persistent vegetative state in Alzheimer disease. Does it exist? Arch Neurol. 1997 Nov;54(11):1382–1384. [PubMed]
  • Ansell BJ, Keenan JE. The Western Neuro Sensory Stimulation Profile: a tool for assessing slow-to-recover head-injured patients. Arch Phys Med Rehabil. 1989 Feb;70(2):104–108. [PubMed]
  • Giacino Joseph T, Ashwal S, Childs N, Cranford R, Jennett B, Katz DI, Kelly JP, Rosenberg JH, Whyte J, Zafonte RD, et al. The minimally conscious state: definition and diagnostic criteria. Neurology. 2002 Feb 12;58(3):349–353. [PubMed]
  • Grubb A, Walsh P, Lambe N, Murrells T, Robinson S. Survey of British clinicians' views on management of patients in persistent vegetative state. Lancet. 1996 Jul 6;348(9019):35–40. [PubMed]
  • Cranford RE. The vegetative and minimally conscious states: ethical implications. Geriatrics. 1998 Sep;53 (Suppl 1):S70–S73. [PubMed]
  • Tresch DD, Sims FH, Duthie EH, Jr, Goldstein MD. Patients in a persistent vegetative state attitudes and reactions of family members. J Am Geriatr Soc. 1991 Jan;39(1):17–21. [PubMed]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Group


Save items

Related citations in PubMed

See reviews...See all...

Cited by other articles in PMC

See all...


  • MedGen
    Related information in MedGen
  • PubMed
    PubMed citations for these articles

Recent Activity

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

See more...