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More On Feeding Tubes

Feeding Tube

We continue to get lots of searches concerning feeding tubes for elderly parents.  Judi wrote about her experience with Audrey, Carol and Judi’s mother.   I think Judi handled the situation well, and her decision was correct.

Many times an aging parent’s physician will recommend a feeding tube offering the rationale that it will make them better.  In cases where there is an acute illness that a feeding tube will help resolve that may be true.  In cases of advanced dementia, that is probably not the case.  A good article here points this out.   The evidence is that feeding tubes do not prolong life, prevent aspiration pneumonia, make the patient more comfortable, or help with pressure sores.

Carol and Judi’s father Frank had several bouts of pneumonia and a doctor in Florida recommended a feeding tube.  My perception is that the pneumonia was aspiration pneumonia all right, but from Frank’s chronic runny nose and inhaling that fluid along with saliva.  I watched him closely at a number of meals and it looked like a lot more food was going onto his clothes than into his lungs.

The New York Times has an ongoing column in the health section titled The New Old Age.  An article entitled An Alternative to the Feeding Tube advocates a number of Palliative care strategies.  I strongly recommend you read the piece.

The Wikipedia article on feeding tubes is here:  “A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing….   

The effectiveness of feeding tubes varies greatly depending on what condition they are used to treat.

There is strong evidence that feeding tubes do not help patients with advanced dementia or adult failure to thrive, and expert opinion recommends they not be offered to these patients. Studies have definitively proven to they do not prolong life, they do not decrease the risk of pneumonia, they do not improve wound healing, they do not help weight gain, and they do not help the patient regain any strength or functional ability such as walking or self-care. Patients with advanced dementia also often pull at their G tubes causing them to be dislodged, and frequently require physical restraints, such as tying their wrists to the bed, to keep this from happening.

There is no evidence that feeding tubes are beneficial in any way for patients who are losing weight with advanced cancer that is not directly related to problems swallowing due to the cancer, such as cancers of the throat or esophagus. Feeding tubes are frequently used in these populations, but studies to date have yet to prove that they are helpful.  

Gastric feeding tubes have a variety of complications that can occur, though the overall rate of complication is about 1%. As gastric feeding tubes are placed as part of a procedure that punches a hole in the stomach and skin, this can lead to leaking of contents into the abdomen causing severe infection and death. This is a rare, but serious complication. 

The most frequent complication is irritation around the site of the insertion, generally caused by stomach acid and feedings leaking around the site. Barrier creams, dressings, and frequent cleaning is generally recommended.  

Especially in advanced dementia, patients can pull at the feeding tubes causing them to be dislodged and requiring a hospitalization to replace them.

Feeding tubes may become clogged or occluded if not flushed with water after each feeding. A clogged tube may need to be replaced.”

I have cut several sections from the article for the sake of brevity.  Here is the link to the full article.

My conclusion is that feeding tubes are not a good choice for a parent who is nearing the end of life.  Some may disagree on moral grounds, but including feeding tubes in “do everything you can” requests will probably do more harm than good.  Consider the first rule of medicine: ” Above all else, do no harm”.

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