NEW YORK, Oct 13 (Reuters Health) -- Elderly patients with advanced dementia often have problems eating, and tube feeding is sometimes introduced to ensure adequate nutrition. But a report published Wednesday in The Journal of the American Medical Association suggests that tube feeding does not benefit, and may even harm, these patients.
"We explain to family members that there is no reason to expect tube feeding will help, and that it may harm the patient," said study co-author Dr. Colleen Christmas in an interview with Reuters Health.
An extensive review of articles published in medical journals between 1966 and 1999 found no formal studies comparing tube feeding with oral feeding in severely demented patients, according to lead author Dr. Thomas Finucane and his associates from Johns Hopkins Geriatrics Center in Baltimore, Maryland.
And what little information exists argues against tube feeding, the investigators report. There is no convincing evidence that tube feeding will reduce the risk of pneumonia or other infections, prevent malnutrition, prolong survival, reduce pressure sores (bedsores), improve functional status, or relieve discomfort in demented patients who cannot feed themselves, the investigators report.
In fact, the researchers note, tube feeding increases the risk of pneumonia and other infections, and results in a host of other ill effects. In two thirds of the cases, feeding tubes must be reinserted, causing further discomfort and risking additional complications.
"The widespread practice of tube feeding should be carefully reconsidered," the authors suggest, "and we believe that for severely demented patients the practice should be discouraged on clinical grounds."
"We believe that a comprehensive, motivated, conscientious program of hand feeding is the proper treatment," the investigators write. "If the patient continues to decline in some clinically meaningful way, tube feeding might be considered... however, all who help make the decision should be clearly informed that the best evidence suggests it will not help."
"It is not unreasonable to forgo unproven and potentially harmful tube feeding therapy when the patient has advanced dementia and lack of nutrition would not be the primary cause of death," agrees Dr. Robert McCann from Highland Hospital/University of Rochester, New York, in a related editorial.
Families are quick to understand the futility of tube feeding, but converting a skeptical nursing home staff can be difficult. "You need a committed staff dedicated to hand feeding," Christmas said, "or you'll have an uphill battle on your hands."
