EthicsThe Standard of Caring: Why Do We Still Use Feeding Tubes in Patients With Advanced Dementia?
Section snippets
Factors Promoting Tube-Feeding
According to the most recent statistics available, the rate of feeding tube use among patients with advanced dementia living in nursing homes varies widely from state to state, ranging from a low of 7% in Maine to a high of 40% in Mississippi.9 It has fallen somewhat from the national average of 34% reported in 2003,10 although the decline is not found in minority populations.11 A large literature has developed that seeks to explain the barriers to change. Several articles address patient
What Matters to Patients and Families Near the End of Life
What matters to patients near the end of life is not uniformly the same as what physicians identify as important. Patients want their symptoms to be controlled, they wish to remain in control, they are concerned about being a burden to their loved ones, and, what is most readily extrapolated to an individual with dementia, they wish to be treated respectfully.17 Cognitively intact dying patients are able to articulate that their dignity is upheld when health care providers affirm their
Feeding Tubes as Caring
Quantitative analysis can provide some help in determining a standard of caring. Investigators have designed instruments to measure pain in advanced dementia21 as well as scales to assess multiple dimensions of suffering.22 These tools can in principle help ascertain whether patients with advanced dementia suffer in the absence of artificial nutrition and hydration. One study of nursing home residents with severe cognitive impairment and pneumonia found that symptoms of discomfort diminished as
A Moral Response to the Feeding Dilemma
A better approach to family members who want feeding tubes for the demented is to acknowledge the symbolic value of nutrition for them and to seek an alternative means of satisfying the need to feed. Hand feeding is one strategy, and when the individual with dementia will eat if fed—albeit typically only very slowly, then this is the approach of choice. It is very labor-intensive and difficult to implement in the nursing home, where many individuals with advanced dementia live, but with a
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Cited by (41)
Palliative Care for Dementia: 2020 Update
2020, Clinics in Geriatric MedicineCitation Excerpt :It is often quite reasonable to forego dietary modifications designed to reduce aspiration risk (thickened liquids, for example) in favor of greater patient comfort and pleasure. Finally, there is limited evidence that appetite stimulants, such as dronabinol or megestrol, may modestly improve intake and quality of life, although improvement in function or life expectancy is rare.44,45,50,51 Hospice and palliative care for dementia is a relatively new area of study.
Palliative Care for Dementia
2018, Psychiatric Clinics of North AmericaESPEN guideline on ethical aspects of artificial nutrition and hydration
2016, Clinical NutritionCitation Excerpt :Patients with dementia who require tube feeding only for a period of time in regard to disease directed treatment with a perspective of oral intake of food again, have an acceptable risk/benefit ratio. As long as patients with dementia have decisional capacity, they have to be included in the communication [25–27]. Artificial nutrition and hydration should be given in any case of uncertain prognosis. [
Dysphagia and Aspiration
2015, Journal of the American Medical Directors AssociationThe god card: Spirituality in the nursing home
2014, Journal of the American Medical Directors AssociationAMDA-Choosing Wisely
2013, Journal of the American Medical Directors Association
The authors have no conflicts of interest pertaining to this article.