Feeding Tubes
Difficulties with eating are a hallmark of end-stage dementia, said Dr. Rachelle E. Bernacki, a hospitalist, geriatrician, and palliative medicine specialist with the University of California San Francisco Medical Center's palliative care service. Approximately one-third of U.S. nursing home residents with advanced dementia are tube fed, but the number of tube-fed dementia patients varies 10-fold across the country.
Tube feeding commonly is used to prevent aspiration pneumonia and provide nutrition in patients who have trouble eating normally. However, no randomized, controlled trials of tube feeding have been published; of the observational studies in the literature, none have shown a reduction in the risk of aspiration and aspiration pneumonia. There is also no evidence of improved nutritional status with the use of feeding tubes, and it does not appear to prolong survival, Dr. Bernacki said.
There are several drawbacks to the use of feeding tubes. The patient does not experience any gustatory pleasure, may experience discomfort, and has diminished social contact.
“As with everything in palliative care, always try to use the goals of therapy as your guide,” Dr. Bernacki said.