Don’t recommend percutaneous feeding tubes in advanced dementia; prefer oral assisted feeding instead.
In advanced dementia, the use of percutaneous feeding tubes does not increase survival, does not lower the risk of aspiration pneumonias, does not improve the healing of existing pressure ulcers (instead, it increases their risk); it augments phsycological stress, the need for physical containment and sedation, the risk of water overcharge, diarrhea, abdominal pain, local complications. The oral assisted feeding improves the nutritional status. However, in the end of life stage, nutrition should be focused on comfort and human relationship rather than on nutritional objectives.
1. Sampson EL, Candy B, Jones L. Enteral tube feeding for older people with advanced dementia. Cochrane Syst Rev 2009 Apr15; (2): CD007209.
2. Palecek EJ, Teno JM, Casarett DJ, Hanson Lc et al. Comfort feeding only: a proposal to bring clarity to decision making regarding difficulty with eating for person with advanced dementia. J Am Geriatr Soc. 2010; 59(3): 580-584.
3. Hanson LC, Carey TS, Caprio AJ, LeeTJ et al Improving decision-making for feeding options in advanced dementia: a randomized controlled trial. J Am Geriatr Soc 2011 Nov 59(11): 2009-2016.
4. Teno JM, Gozalo, PL, Mitchell SL, Does feeding tube insertion and its timimg improve survival? J Am Geriatr Soc 2012 Oct, 60(10): 1918-21.
5. Van der Steen JT, Radbruch L, MPM Hertogh C, de Boer ME, Hughes JC, Larkin P, et al. White paper defining optimal palliative care in older people with dementia: A Delphi study and recommendations from the European Association for Palliative Care. Palliative Care 2013; 0: 1-13, DOI: 10.1177/0269216313493685
Attention. Please note that these items are provided only for information and are not intended as a substitute for consultation with a clinician. Patients with any specific questions about the items on this list or their individual situation should consult their clinician.