NEW YORK, Jan 20 (Reuters Health) -- In patients with advanced dementia,
tube feedings can cause more suffering than relief. Health care providers should
recommend that these patients forego artificial nutrition, a physician argues in
the January 20th issue of The New England Journal of Medicine.
Gastrostomy tubes, which deliver fluid and nutrients directly to a
patient's stomach, are being used more often than in the past, according to Dr.
Muriel R. Gillick of the Hebrew Rehabilitation Center for Aged in Boston,
Massachusetts. However, data suggest they are not effective at prolonging life
or ensuring adequate nutrition.
"Physicians, professional organizations, hospitals, and nursing homes
should recommend to patients and their families that nutrition be provided
orally, not through a feeding tube, during the final stage of dementia," Gillick
writes.
She estimates that there are about 4 million people in the United States
with Alzheimer's disease or other types of dementia. Patients in the final
stages of such illnesses are unable to walk, feed themselves, or have
relationships with other people.
Tube feedings can provide fluid and nutrients to patients who have
difficulty swallowing or lose interest in eating. But patients with severe
dementia tend to pull out tubes, Gillick explains. Common problems such as
diarrhea and tube clogging can also compromise nutritional status, she adds.
Studies have also failed to confirm the belief that tube feedings prolong
life for patients with dementia or prevent a protracted death from starvation
and dehydration.
"A growing literature from the hospice movement indicates that such
patients do not experience more than transient hunger and that any thirst they
experience can be assuaged with the use of ice chips and mouth swabs," Gillick
states.
"Moreover, many elderly patients do not feel distress from dehydration
because they have an impaired thirst mechanism," she notes.
Gastrostomy tubes may also cause pain from superficial skin infections
where the tube has been surgically inserted through the abdominal wall, or by
becoming clogged or dislodged.
Oftentimes, patients need to be restrained from pulling the tube out, said
Gillick, who cites a study in which 71% of patients with dementia who had
feeding tubes were restrained.
Ethical and religious arguments add little weight in favor of tube
feeding, as bioethicists and religious ethicists have come to the conclusion
that tube feeding should not be required for patients with advanced dementia.
"In summary, data collected over the past decade suggest that gastrostomy
tubes are not necessary to prevent suffering and may actually cause suffering,"
Gillick concludes.
