Health Column: Feeding tubes in severely demented patients
MOHLER’S MEDICATION MAXIMS
Free Press Health Columnist
Geraldine was 84 when her daughter Linda moved her into a Alzheimer’s unit five years ago. Geraldine’s dementia progressed and she became bedfast and totally dependent on her caregivers. She experienced difficulties with chewing and swallowing her food. Her weight went down five pounds in six weeks. Then Geraldine experienced an episode of choking during a meal and was hospitalized with aspiration of food into her lungs. Geraldine’s physician called her daughter, Linda, suggesting a feeding tube. Put yourself in Linda’s shoes. What would you want for your mom, or for yourself?
Family members and physicians are often attracted to the perceived benefits of providing artificial nutrition and hydration to patients with severe dementia. Feeding tubes inserted through the nose or implanted through an incision in the wall of the abdomen (PEG tube) have been promoted as a method to improve nutrition, maintain skin integrity, prevent aspiration pneumonia, minimize suffering, improve functional status, and extend life.
Additionally, providing artificial nutrition and hydration has been associated with caring and nurturing while forgoing these measures has been equated with neglect and abandonment. Thus, when caretakers are faced with the decision of whether or not to provide artificial nutrition and hydration, it seems sensible to provide it by any means.
Families want to do everything possible for someone who is ill. But they often get little information about feeding tubes. And they may feel pressure from doctors or nursing home staff, because feeding is simpler with a feeding tube.
Feeding tubes sometimes do more harm than good. Here’s why:
The American Geriatrics Society in their May 2013 position statement declared: ”Tube feeding is not better than careful hand feeding —and it may be worse.” Multiple studies have shown that tube feeding does not help people live longer, gain more weight, become stronger, or regain skills. And it may increase the risk of pneumonia and pressure sores.
On the other hand, hand feeding gives human contact and the pleasure of tasting favorite foods. When death is near and patients can no longer be fed by hand, families often worry that the patient will “starve to death.” In fact, refusing food and water is a natural, non-painful part of the dying process.
Tube feeding also has some risks:
It can cause bleeding, infection, skin irritation, or leaking around the tube.
It can cause nausea, vomiting, and diarrhea.
Many people with Alzheimer’s disease are bothered by the tube and try to pull it out. To prevent that, they are often tied down or given drugs.
Tube-fed patients are more likely to get pressure sores.
What did Linda decide to do? Linda opted not to use a feeding tube for her mother after a long discussion with Geraldine’s physician. She got HopeWest (hospice) involved to maximize her mother’s comfort. For the last nine months of Geraldine’s life, Linda went to the nursing home twice a day to feed her mom.
Plan ahead. Every adult should have an advance directive. It lets you say what kind of care you want and perhaps more importantly, what you don’t want.
Download the Colorado MOST form (Medical Orders for Scope of Treatment) at http://www.polst.org/educational_resource/oregon-polst-form and discuss it with your physician at your next visit. Your doctor has copies of the MOST form as well.
GJ Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at firstname.lastname@example.org.
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