Feeding Tubes Shouldn’t Be Needed for Dementia Patients

A study from Brown University, published in the Journal of the American Medical Association, has shown that larger, for-profit hospitals are more likely than smaller, non-profit hospitals to insert feeding tubes during acute-care admissions of nursing-home patients.  It’s simplistic to conclude that the profit motive is responsible for this difference, but clearly it’s time to re-evaluate the need for feeding tubes in such patients.  This is more important now that US Catholic bishops have announced that it’s not permissible to remove a feeding tube from someone who is not dying, except in rare circumstances.

Back in October last year the New England Journal of Medicine published an analysis of the clinical course of advanced dementia patients. Boston researchers studied 323 patients from 22 nursing homes, gathering clinical data and interviews with the patients’ health proxies.  About 70% of the patients had Alzheimer’s, and 17% had vascular dementia.  Over 40% of the patients developed pneumonia, 50% had at least one febrile episode, and 85% developed eating problems; 55% of them died during the 18 months study period.

During their final 3 months of life, over 40% of the patients had at least one ‘intensive intervention’ such as hospitalization, visit to the ER, tube feeding, or intravenous treatment. It was notable, however, that when the patient’s health proxy or surrogate understood the expected short time remaining, these interventions were much less likely, compared to those patients with less well-informed proxies.

It was also found that, in general, patients who could eat normally were not likely to die within the study period – only about 10% - compared with the 70% deaths in those with eating problems at some point.

I believe it’s time to ensure that health proxies are aware of the inevitability of death in advanced dementia patients who show one or more of the common complications – pneumonia, fever, and eating problems.  The remaining time available to these patients should not be burdened by distressing interventions, such as the use of tube feeding or intravenous nutrition.  And removal to hospital should be a well-studied decision, not just a speedy shifting of responsibility to another institution.