Tube Feeding Not Beneficial In Patients With Advanced Dementia

WESTPORT, Oct 13 (Reuters Health) - Tube feeding of advanced dementia patients offers no clinical benefits and may cause harm, according to a review published in the October 13th issue of The Journal of the American Medical Association. Dr. Thomas E. Finucane and colleagues, from Johns Hopkins Bayview Medical Center in Baltimore, Maryland, reviewed the medical literature from 1966 through March 1999 to determine whether or not tube feeding of advanced dementia patients accomplished any of the objectives for which tube feeding is intended.

"We...found no relevant randomized clinical trials comparing tube feeding with oral feeding in the severely demented. Thus, a meta-analysis was not possible; rather, we have presented a summary of the data available," the investigators explain. The Baltimore group reports that they were unable to identify any published studies suggesting that tube feeding reduces the risk of aspiration pneumonia, prevents malnutrition, prolongs survival, improves pressure sore outcomes, reduces the infection rate, improves functional status, or provides increased comfort to dysphagic demented patients.

In fact, Dr. Finucane's team notes, tube feeding increases the rate of aspiration pneumonia and causes a variety of infections. Furthermore, a host of adverse effects accompany the use of tube feeding, and "[a]pproximately two thirds of nasogastric tubes require replacement."

"The widespread practice of tube feeding should be carefully reconsidered," the authors conclude, "...and we believe that for severely demented patients the practice should be discouraged on clinical grounds."

"We believe that a comprehensive, motivated, conscientious program of hand feeding is the proper treatment," Dr. Finucane and colleagues write. "If the patient continues to decline in some clinically meaningful way, tube feeding might be considered as empirical treatment; however, all who help make the decision should be clearly informed that the best evidence suggests it will not help."

"Families should be presented with reasonable alternatives to tube feeding and educated in ways that they can provide comfort and support to their loved ones," Dr. Robert McCann, from Highland Hospital/University of Rochester in New York, agrees in a related editorial.

He adds, "It is not unreasonable to forgo unproven and potentially harmful tube feeding therapy when the patient has advanced dementia and lack of nutrition would not be the primary cause of death."

Convincing families to forgo tube feeding is not the major challenge, Dr. Colleen Christmas, one of the study co-authors, suggested in an interview with Reuters Health. "Families are surprisingly sophisticated these days," she said. "Provided the information we discuss in the article, families will reach good, informed decisions."

But converting a skeptical nursing home staff can be difficult, Dr. Christmas continued. "You need a committed staff dedicated to hand feeding, or you'll have an uphill battle on your hands."
JAMA 1999;282:1365-1370,1380-1381.