Monday, 28 October 2013

Feeding Tubes for People with Alzheimer’s Disease : When You Need Them—And When You Don’t

Most people in the last stage of Alzheimer’s disease have difficulty eating and drinking. At this time, families may wonder if a patient needs a feeding tube. Families want to do everything possible for some-one who is ill. But they often get little information about feeding tubes. And they may feel pressure from doctors or nursing home staff, because feeding is simpler with a feeding tube.

But feeding tubes sometimes do more harm than good. Here’s why:
Feeding tubes usually aren’t helpful for severe Alzheimer’s disease. People with severe Alzheimer’s disease can no longer communicate or do basic things. Chewing and swallowing is often hard. This can cause serious problems, such as weight loss, weakness, and pressure sores. Or food can get into the lungs, and cause pneumonia. So people often need help when eating.  In many cases, a decision is made to use a feeding tube. The tube may be put down the throat. Or it may be put through a small cut in the abdominal wall, into the stomach. The patient is then given liquid nutrition through the tube.

But tube feeding is not better than careful hand feeding —and it may be worse. It does not help people live longer, gain more weight, become stronger, or regain skills. And it may increase the risk of pneumonia and pressure sores. Hand feeding gives human contact and the pleasure of tasting favorite foods.

When death is near and patients can no longer be fed by hand, families often worry that the patient will “starve to death.” In fact, refusing food and water is a natural, non-painful part of the dying process.  There is no good evidence that tube feeding helps these patients live longer.

Feeding tubes can have risks.

Tube feeding has many risks: 
•  It can cause bleeding, infection, skin irritation, or leaking around the tube. 
•  It can cause nausea, vomiting, and diarrhea.
•  The tube can get blocked or fall out, and must be replaced in a hospital. 
•  Many people with Alzheimer’s disease are bothered by the tube and try to pull it out. To prevent
    that, they are often tied down or given drugs. 
•  Tube-fed patients are more likely to get pressure sores. 
•  Tube-fed patients are more likely to spit up food, which may lead to pneumonia. 
•  At the end of life, fluids can fill the patient’s lungs, and cause breathing problems.

Feeding tubes can cost a lot.  Putting in a feeding tube costs about $8,269, according to

So when are feeding tubes a good idea?
Feeding tubes can be helpful when the main cause of the eating problem is likely to get better. For example, they can help people who are recovering from a stroke, brain injury, or surgery.

The tubes also make sense for people who have problems swallowing and are not in the last stage of an illness that can’t be cured. For example, they can help people with Parkinson’s disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

(Source:  The American Geriatrics Society, 17 September 2013)

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