This article addresses feeding and eating difficulties resulting in weight loss during the advanced stages of dementia, and the decision-making process regarding use of a percutaneous endoscopic gastrostomy tube. Evidence from observational studies indicates that feeding tubes do not improve survival or reduce the risk of aspiration, yet feeding tubes are used commonly in patients with dementia.
Nursing home residents often do not have orders about the use of artificial hydration and nutrition, and such orders to forgo artificial hydration and nutrition may be misinterpreted as “do not feed”; with a corresponding reluctance of families to give consent. Nursing homes may fear regulatory scrutiny of weight loss and use feeding tubes to indicate that everything possible is being done.
This range of misunderstandings and challenges may be overcome by the adoption of clearer language which stresses the patient’s goals of care. A new “comfort feeding only” order, used in conjunction with an individualised feeding care plan, is proposed. Comfort feeding given through careful hand feeding, where possible, is a preferable alternative to tube feeding, eliminating the false care/no care dichotomy imposed by orders concerning artificial hydration and nutrition.
Palecek, EJ. Teno, JM. [and] Casarett, DJ. [et al] (2010). Comfort feeding only: a proposal to bring clarity to decision-making regarding difficulty with eating for persons with advanced dementia. Journal of the American Geriatrics Society, 2010, Vol.58(3), pp.580-4. (Click here to view the PubMed abstract).