New York, NY – Older adults who have end-stage dementia and can no longer feed themselves should not be fitted with feeding tubes, but rather, should be carefully fed by hand, recommends the American Geriatrics Society’s (AGS’) newly updated position statement on the use of percutaneous endoscopic gastrostomy (PEG) tubes among this population.
“In 2005, when the AGS last updated its position on the use of PEG tubes among these vulnerable older adults, evidence that the tubes were problematic for these patients was emerging,” says AGS President Cathy Alessi, MD. “Since then, a significant body of high quality observational research has confirmed that feeding tubes do not benefit these vulnerable adults. Instead, they often do harm. In light of this, the society’s updated position statement strongly recommends that older adults with advanced dementia receive careful hand-feeding instead.”
Introduced in 1980, PEG tubes were expected to help prevent malnutrition, functional decline, pressure ulcers, and both aspiration and resulting pneumonia among these patients. Growing research, however, confirms that tube-feeding not only increases the risks of these outcomes, but also causes discomfort, agitation, and often leads to serious complications. Because the tubes are uncomfortable, patients frequently try to remove them – dislodging the tubes and necessitating emergency room (ER) treatment and hospitalizations. To prevent patients from removing the tubes, they are often restrained.
“In contrast to tube feeding, hand feeding reduces risks of aspiration and pneumonia, ER and hospital visits, pressure sores, and the use of restraints,” notes Dr. Alessi. “Hand feeding is a win-win for these older patients. Not only does it spare them the adverse effects associated with tube-feeding, it provides these patients with the comfort that being gently fed, by hand, affords.”
Patients and their caregivers should, as soon as possible, take steps to make sure that they receive the care they prefer at the end of life. Even when formal steps haven’t been taken ahead of time, there are ways family members can help provide a relative with end-of-life care in keeping with his or her preferences.
AGS’ position statement acknowledges that there are circumstances in which providing temporary, short-term tube feeding may be appropriate – such as when a patient has had a stroke that is causing swallowing problems that will resolve over time. In these cases, the goals of the treatment should be identified before the feeding tube is inserted, and the patient’s status reviewed frequently, to ensure that the benefits of tube-feeding continue to exceed drawbacks.
The AGS Feeding Tubes in Advanced Dementia Position Statement is available at www.americangeriatrics.org/feedingtubes. As part of the American Board of Internal Medicine (ABIM) Foundation’s Choosing Wisely® campaign, designed to educate the public on the overuse of certain medical tests and procedures, the AGS and the American Academy of Hospice and Palliative Medicine included the use of feeding tubes in patients with advanced dementia among their Choosing Wisely list of “Five Things Physicians and Patients Should Question.”
Consumer Reports, a partner in the Choosing Wisely® campaign, has developed a patient education article about feeding tubes, sponsored by the AGS and AAHPM, that is available at www.healthinaging.org/feeding tubes.