Tube Feeding in Individuals with Advanced Dementia: A Review of Its Burdens and Perceived Benefits

Abstract

Background. Dementia remains a growing concern for societies globally, particularly as people now live longer. About 90% of individuals with advanced dementia suffer from eating problems that lead to general health decline and ultimately impacts upon the physical, psychological, and economic wellbeing of the individuals, caregivers, and the wider society. Objective. To evaluate the burdens and perceived benefits of tube feeding in individuals with advanced dementia. Design. Narrative review. Methods. Computerized databases, including PubMed, Embase, Medline, CINAHL, PsycInfo, and Google Scholar were searched from 2000 to 2019 to identify research papers, originally written in or translated into English language, which investigated oral versus tube feeding outcome in individuals with advanced dementia. Results. Over 400 articles were retrieved. After quality assessment and careful review of the identified articles, only those that met the inclusion criteria were included for review. Conclusion. Tube feeding neither stops dementia disease progression nor prevents imminent death. Each decision for feeding tube placement in individuals with advanced dementia should be made on a case-by-case basis and involve a multidisciplinary team comprising experienced physicians, nurses, family surrogates, and the relevant allied health professionals. Careful considerations of the benefit-harm ratio should be discussed and checked with surrogate families if they would be consistent with the wishes of the demented person. Further research is required to establish whether tube feeding of individuals with advanced dementia provides more burdens than benefits or vice-versa and evaluate the impacts on quality of life and survival.

Attitude and experience of neurologists towards percutaneous endoscopic gastrostomy: an Egyptian study

“…This reflects the growing recognition of the importance and benefits of PEG feeding among Egyptian neurologists, as we mentioned lately. This experience is globally adopted by neurologists and has been studied in some other studies over the last 20 years [17,18,22,26,28]. Similarly, they reported a very satisfactory experience to the caregivers in over half (52.3%) of the cases they referred to perform PEG.…”

“…The family usually goes against PEG for the mistaken idea about the PEG feeding is burdensome or even dangerous to apply, fearing of the surgical procedure itself, or the inability to handle and provide proper care, or altering body image [23]. This requires compassion and time from the physician and healthcare providers to discuss the rationale and the benefits of PEG feeding [24][25][26].…”

“…Although the reported incidence of leakage used to be much lower in older studies, it is in fact a much more common complication as reported in more recent studies. Several factors that can increase the risk of leakage have been identified, including gastric hypersecretion and excessive cleansing with hydroperoxide, as well as other specific factors related to the patient that inhibit wound healing such as poor baseline nutritional status, diabetes, and immunodeficiency [26,31,34].…”

“…In some older studies, it was reported to be as high as 65% [36,37]. Once again, mild redness around the tube insertion site is common due to tube movement which is considered acceptable; however, more severe redness, purulent discharge, and signs of systemic infection must raise the possibility of wound infection [26,[32][33][34][35].…”

Advancing Nutrition and Dietetics Practice: Dealing With Ethical Issues of Nutrition and Hydration

“…Consideration of the individual's prior wishes and recognition that tube feeding cannot stop the progression of dementia nor prevent imminent death should be shared with family caregivers. 16 Change in clinical practice from placing long-term feeding tubes in patients with advanced dementia could be enhanced by the use of an algorithm for decision making or a checklist of appropriate indications for use before the placement of long-term enteral access devices. 17…”