Study Examines Necessity of Feeding Tubes in Elderly

Feeding Tubes in ElderlyIt can be extremely difficult for patients with advanced dementia to eat. Especially swallowing is difficult for these patients. Some doctors are more likely to use gastric feeding tubes with patients who suffer from advanced dementia instead of opting to feed these patients by hand. These results were evident in a study that was recently published in the Health Affairs journal.

According to Joan Teno – professor of Medicine and the lead on the study – the efficacy of feeding tube use has become something of a controversial topic in the last few years. The evolving literature does not suggest that feeding tubes help prevent pressure ulcers, do not prevent aspiration pneumonia, and do not improve the patient’s chance of survival. This leads to Teno asking the question: why are we still using this method?

The frequency is variable

According to Teno, the frequency of feeding tube insertion is highly variable. In some fields of medicine, the doctor will request a feeding tube in upwards of 44 percent of patients with advanced dementia. Meanwhile, in other forms of medicine that number stands at a modest 4 percent of patients with advanced dementia.

New doctor = feeding tube?

According to the research from Teno, one of the most problematic aspects was the introduction of a new physician in the care process. She believes that this handoff may be partially responsible for the increased rates of feeding tube use.

The study revealed that hospitalists and primary care physicians had the same low rate of feeding tube use. However, if a subspecialist is added to the discussion, the use of feeding tubes often increased.

Not always beneficial

According to Teno, it is important that doctors be careful when using feeding tubes at all. Especially in patients with dementia, the disadvantages often outweigh the advantages. An earlier study from Teno revealed that those patients who received a feeding tube were more likely to develop a stage 2 or higher pressure ulcer than those who did not.

Even when adjusting the risks, Teno said in her earlier research (published in the Archives of Internal Medicine) that with a feeding tube, the patients run a 2.27 times higher risk of developing a pressure ulcer than without it.

The central question

The central question with the use of feeding tubes is whether it will actually improve the patient’s quality of life. This study (and other studies done before it) shows that it may increase rates of pressure ulcers and cause many people agitation instead of improving their overall quality of life.

According to Teno, these cases would benefit from a ‘less is more approach’. This means diligently offering the patient food and to help them regain their appetite through hand feeding. Teno feels that the most important thing to take away from her study is the fact that subspecialists need to be educated about the benefits and risks that come with feeding tube insertion for elderly patients with dementia. Even though hand feeding may take far more time, it appears to be the preferable option.

Yellow-CTA

Justia Lawyer Rating for Jonathan Rosenfeld

Client Reviews

★★★★★
Jonathan did a great job helping my family navigate through a lengthy lawsuit involving my grandmother's death in a nursing home. Through every step of the case, Jonathan kept my family informed of the progression of the case. Although our case eventually settled at a mediation, I really was impressed at how well prepared Jonathan was to take the case to trial. Lisa
★★★★★
After I read Jonathan’s Nursing Home Blog, I decided to hire him to look into my wife’s treatment at a local nursing home. Jonathan did a great job explaining the process and the laws that apply to nursing homes. I immediately felt at ease and was glad to have him on my side. Though the lawsuit process was at times frustrating, Jonathan reassured me, particularly at my deposition. I really felt like Jonathan cared about my wife’s best interests, and I think that came across to the lawyers for the nursing home. Eric