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Help or Harm: Feeding Tubes in Advanced Dementia
Family members grappling with the decision to allow a feeding tube for a relative with advanced dementia will find little comfort from a new review of evidence.
Poor food intake is common in individuals with dementia for a variety of reasons. In advanced dementia, health care providers might intervene by feeding patients artificially, usually by inserting a feeding tube through the stomach. This decision is emotional, controversial and influenced by complex ethical issues.
But do feeding tubes actually help people with degenerative dementia? In a new Cochrane review from London, doctors searched for evidence that this intervention was beneficial. “We found that there is no research evidence that tube feeding prolongs survival or improves the quality of life for people with advanced dementia,” said lead author Elizabeth Sampson, M.D. “In fact, some studies suggest that tube feeding may have an effect opposite to the desired and actually increase mortality, morbidity and reduce quality of life.”
At first glance, it appears counterintuitive that individuals fail to benefit from tube feeding, but the way that the body utilizes food is complex, Sampson said. With some forms of dementia, the body might be unable to metabolize food properly. Especially worrisome for families is the pain typically associated with prolonged hunger and thirst.
“In a study with patients terminally ill with advanced cancer and unable to eat, however, few experienced painful feelings of hunger and thirst,” Sampson said. “If they did, this pain was alleviated by simple measures, such as pain relief or small sips of water.
Compassionate nursing and medical care - similar to that which underlies the philosophy of the hospice movement - can alleviate a great deal of suffering and should be available to people with dementia, too.”
It is important to realize that the gastrointestinal system of patients close to death often shuts down and a feeding tube can cause considerable suffering. The choice is not either a feeding PEG or nothing. There is a third option that people have been using since the beginning of time: assisted oral feeding.
The researchers said the most important thing a loved one can do is to routinely stop by the nursing home on the way to or from work, and spend a half an hour doing assisted oral feeding.
REHACARE.de; Source: Health Behavior News Service
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