Blog | Wednesday, July 23, 2014

QD: News Every Day--Don't use feeding tubes for advanced dementia, geriatrics society says

Feeding tubes are not recommended for older adults with advanced dementia, according to a position statement from the American Geriatrics Society. They don’t prevent complications of hand feeding, led to complications, and take away life’s simples pleasures of eating and interacting with others.

Hand feeding is at least as good as tube feeding for the outcomes of death, aspiration pneumonia, functional status, and comfort, the statement reads, and tube feeding is associated with agitation, greater use of physical and chemical restraints, tube-related complications, and development of new pressure ulcers.

The position statement appeared online July 17 at the Journal of the American Geriatrics Society.

Among the rationales:
• Survival is not better in those who are tube fed rather than hand fed;
• There’s no evidence that tube feeding prevents aspiration, heals pressure ulcers, improves nutritional status, or decreases mortality;
• Tube feeding is associated with aspirations, malfunctions, oral secretions that are difficult to manage, discomfort, use of physical and chemical restraints, and pressure ulcers;
• Nursing home residents frequently need to be transferred to the emergency department to address tube-related complications such as blockage and dislodgement; and
• Greater levels of discomfort have not been observed, despite eating difficulties.

The position statement recommended involving families about the natural progression of dementia, including eating difficulties, and acting proactively to make decisions through advance directives. It also suggested enhance oral feeding by altering the environment and creating individual-centered approaches.

“Oral feeding may be one of few remaining pleasures and a time for socialization for a person with advanced dementia,” the statement reads. “Mealtime must be regarded as an event of importance, instead of a task that needs to be completed as soon as possible.”