Once eating difficulties arise in patients with advanced dementia, family caregivers are often faced with the difficult decision to place, or not place, a feeding tube for nutritional support. This decision can challenge different people’s cultural beliefs, can include pressure from healthcare providers, and in many cases, may be made without enough information about the impact of inserting a feeding tube.
Research on the use of feeding tubes in persons with advanced dementia is emerging, and is summarized in a position statement published by the American Geriatrics Society (AGS).
In the statement, the AGS advises:
- Feeding tubes are not recommended for older adults with advanced dementia. An alternative approach that provides the same nutritional benefits is hand or spoon feeding. In fact, tube feeding can lead to harmful side effects, including worsening pressure ulcers.
- Research suggests that patients with advanced dementia should be hand or spoon fed in a quiet and calm environment. Environments with less noise and clutter are more conducive to eating than chaotic ones.
- The decision to insert a feeding tube can be made by a patient’s surrogate decision-maker. When patients lose their capacity to consent to treatments, their previously expressed directives, wishes or values can be executed by this person.
- Discussion of advance directives regarding feeding support should begin early in the course of illness, and should not be delayed until a crisis develops.
- Hospitals, nursing homes, and other care settings should promote choice, endorse shared and informed decision-making, and honor patient preferences regarding tube feeding. They should not impose obligations or exert pressure on patients or providers to institute tube feeding.
Before making a decision on the use of a feeding tube versus hand-feeding, take some time to read and consider the following resources developed by HealthinAging.org in collaboration with the AGS.
- AGS' Updated Feeding Tubes Position Statement (May 2013)
- AGS Supports Evidence-Based, Patient-Centered Use of Feeding Tubes in Advanced Dementia
Last updated: February 2013