When Evidence Clashes With Emotion: Feeding Tubes In Advanced Dementia

I read with great interest the article regarding the updated position statement of the American Geriatric Society (AGS) Ethics Committee and AGS Clinical Practice and Models of Care Committee on the use of feeding tubes in adults with advanced dementia, including the accompanying interview with Ramona Rhodes, MD, MPH, MSCS, AGSF, in the September 2014 edition of Annals of Long-Term Care: Clinical Care and Aging®. The updated position statement, which presents a recommendation against the use of feeding tubes for older adults with advanced dementia, represents a remarkable advancement towards ensuring quality geriatric patient care. The article addressed in detail various aspects of care relating to feeding tube placement in this patient population and highlighted the AGS’s recommendation that hand-feeding be used as an alternative approach to feeding patients with advanced dementia.^1,2 However, the feasibility of this practice is greatly limited by issues of both cost³ and staffing.⁴

Family involvement in hand-feeding of older adults with advanced dementia living in long-term care settings may be a potential option worth exploring in addressing these limitations. Studies have shown that most relatives of older persons admitted to long-term care facilities are interested in continuing to be involved in their lives.^5,6 Family members who assisted their older relatives with meal times at home are especially willing and able to assist them in settings outside the home, thereby creating a more familiar social context with the potential to reduce eating problems⁷ and promote patient comfort and more intimate patient care.²

Family involvement could mitigate the barriers of cost and staffing to implementing AGS’s recommendation of hand-feeding of older adults with advanced dementia and may also help to promote a sense of well-being, satisfaction and perception of quality care for all involved. Undoubtedly, ongoing education of family caregivers is needed to ensure adequate understanding of disease progression and perception of feeding needs. Further research on the applicability of such an approach in institutionalized settings is needed.

1.    Garrow D, Pride P, Moran W, Zapka J, Amella E, Delegge M. Feeding alternatives in patients with dementia: examining the evidence. Clin Gastroenterol Hepatol. 2007; 5(12):1372-1378.

2.    Li I. Feeding tubes in patients with severe dementia. Am Fam Physician. 2002;65(8):1605-1610.

3.    Mitchell SL, Buchanan JL, Littlehale S, Hamel MB. Tube feeding versus hand-feeding nursing home residents with advanced dementia: a cost comparison. J Am Med Dir Assoc. 2004; 5:S22-S29.

4.    Simmons SF, Osterweil D, Schnelle JF. Improving food intake in nursing home residents with feeding assistance: a staffing analysis. J Gerontol A Biol Sci Med Sci. 2001;56(12):M790-M794.

5.    Hertzberg S, Ekman K. Axelsson staff activities and behavior are the source of many feelings: relatives‚Äô interactions and relationships with staff in nursing homes. J Clin Nurs. 2001;10(3):380-388.

6.    Kellett UM. Transition in care: family carers‚Äô experience of nursing home placement. J Advanced Nurs. 1999;29(6):1474-1481.

7.    Amella EJ, Lawrence JF. Eating and feeding issues in older adults with dementia: part ll: interventions. Annals of Long-Term Care: Clinical Care and Aging. 2008;16(4):17-54.