Are Feeding Tubes Good for People with Advanced Dementia?
When we think about Alzheimer’s and other types of dementia, we typically focus on the memory loss that these diseases cause. What’s sometimes overlooked is that people with advanced dementia lose the ability to chew and swallow without choking and aspirating food into their lungs. Years ago, doctors often recommended surgery to put a feeding tube in the patient’s abdomen. After years of studies, though, feeding tubes are no longer recommended for patients with late-stage dementia, and the New York Times says more families are opting to stick with hand feeding instead. Here’s why.
Non-profit group Choosing Wisely notes that feeding tubes do have their uses. Patients who can’t swallow (but don’t have a life-ending illness) and people recovering from trauma or surgery can benefit from the nutrients a tube can deliver. For people with advanced dementia, the outcomes are different.
Feeding tubes carry some risks for late-stage dementia patients
The American Geriatrics Society’s position is that “when eating difficulties arise, feeding tubes are not recommended for older adults with advanced dementia.” AGS says that’s because tube feeding these patients raises their risk of
- agitation, which can require “physical and chemical restraints” to subdue
- pressure sores, which can be painful and lead to infection
- more medical procedures related to problems with the tube itself, such as trips to the ER to unblock a clogged tube
AGS also says “feeding tubes should never be viewed as a cheaper, more efficient way of feeding,” and that the choice of whether or not to have a feeding tube surgically inserted should be up to the family based on advanced directives or patient wishes. Doctors may offer the option, but the final decision should be based on the patient’s wishes.
Feeding tubes don’t help advanced dementia patients live longer
Dementia patients who develop trouble swallowing are making what the AGS describes as the “transition from advanced dementia to the end of life,” and about half of these patients will die within six months. This is a hard, heartbreaking thing to accept, and it’s natural to hope that nutrition delivered by tube would give patients more time. However, studies of healthcare outcomes have found “a short survival time after feeding-tube insertion.” For patients who needed their feeding tubes replaced or re-positioned, the median survival time was less than two months. The Alzheimer’s Association also says that feeding tubes don’t reduce the likelihood of pneumonia caused by food aspiration.
Alternative feeding approaches for people with severe dementia
Both the Alzheimer’s Association and the AGS recommend feeding patients by hand if the patient is comfortable with it and can safely take in some food or liquid. In part, this is because meals are a sensory pleasure and a time to have social contact with others – two things tube feeding can’t provide. For patients whose appetite is declining, Consumer Reports Health suggests that caregivers:
- Look for and treat underlying causes of appetite loss, such as infection or depression
- Ask the doctor if medications may be making a weak appetite worse
- Make a dental appointment to look for potential tooth and denture problems