Feeding tube gastrostomy, PEG, feeding disorder in dementia

The issue of feeding in patients with dementia is complex. The feeding disorder, dysphagia, swallowing problms result in inadequate feeding or nutrition are common in dementia patients. A feeding tube (PEG or surgical gastrostomy) is often done. The question is, does it help? Are we helping our loved ones or are we just making ourselves good. If you were the one making the determnation for your elderly loved one and were told that such feeding tubes, PEG (gastrostomy tube) are unlikely help in anyway or change anything, what would you think? What would be your position when asked for consent?

A recent study examined  the issue of published evidence related to alternative feeding via tubes in patients with dementia. Garrow and colleagues reviewed the evidence found that available evidence does not support any beneficial impact of artificial feeding on survival, pressure ulcers, nutritional status, or aspiration pneumonia. The authors suggest that hand feeding may be a viable alternative in such patients although there is no head-to-head comparison of such feeding with artificial feeding via gastrostomy tube, whether surgical or endoscopic (PEG).

Finucane and colleagues argue that medical system favors use of tube feeding despite lack of beneficial effect, and affects decision-makers, physicians and administrators . There is constant urge to "do something" in sick patients especially when clinical situation is turning downhill.  The medical system wishes to avoid regulatory sanctions, bad publicity, and risk for malpractice law suits.

Getting back to our original question, should the medical system withold feeding tubes in case of patients with dementia unable to feed themselves adequately? How would you react as surrogate decision maker regarding giving consent for feeding tube in your loved one with dementia who is ingest himself or herself. 

Comments

[Chris]

No dementia here no stroke nothing you would normally deal with maybe.......but I do have a PEG can speak for and care for myself and it keeps me alive as there is no other way of "eating" for me! My blog will explain!

[Speechie Keen]

Interesting you say in your post that the medical profession favors the use of PEGs despite the lack of evidence to support their benefit in dementia patients for fear of potential consquences and to appease families who feeling like they're doing something for their loved ones.

Fortunately the system is slightly different in Australia where doctors don't experience the same threat of malpractice. In my experience in this situation, everything is done to avoid PEG insertion, such as modifying diet, eliminating any medications that could impact on feeding and individualized feeding techniques. Frequently families are faced with the knowledge that their loved one may be eating and drinking while at risk of aspiration or further complications.

I'd refer you and your readers to an interesting article published very recently in JAMA titled 'A 93 year old man with advanced dementia and eating problems' in the December 5 2007 edition Vol 298, No 21.

HNY to all..

SK