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.