Difficult decisions facing Alzheimer’s and other advanced dementia patients must be made with careful consideration for the health and well-being of patients and their caregivers. A report in Nutrition in Clinical Practice, entitled, “Gastrostomy Tube Placement in Patients With Advanced Dementia or Near End of Life,” recommends feeding tubes not be used in such patients.
“Current scientific evidence suggests that the potential benefits of tube feeding do not outweigh the associated burdens of treatment in persons with advanced dementia,” wrote the authors, as reported by the American Society for Parenteral and Enteral Nutrition. “Studies consistently demonstrate a very high mortality rate in older adults with advanced dementia who have feeding tubes.”
End of life decisions such as the use of a feeding tube are ones that are often made based on the emotions and wishes of friends and families who are left to care for a dying loved one. However, this new study, which was headed by Dr. Denise Baird Schwartz, a researcher at Providence Saint Joseph Medical Center, provides clinical evidence about the effect that feeding tubes have on Alzheimer’s and dementia patients. The authors acknowledged the presence of numerous scientific articles focused on feeding tubes and advanced dementia patients. After evaluating the literature, the authors came to the conclusion that patients and their families must thoroughly discuss the risks, burdens, and benefits of using a feeding tube in order to make an informed decision. Although it is a sensitive subject, the authors stressed the importance of reaching an agreement that respects patient independence and dignity.
Choices such as these that must be made in end-of-life planning are a part of individualized treatment plans for Alzheimer’s patients. Hospitals and long-term care facilities can promote informed decisions by developing a process that considers patients’ and families’ wishes and best interests.