INFORMATION FOR CONSUMERS

Making the Decision:
Tube Feeding - Frequently Asked Questions

What is a feeding tube?

Feeding tube may provide nutrition to people who have difficulty swallowing or unable to eat for medical reasons. A feeding tube is device which transports liquid nutrition to your stomach. A feeding tube can be inserted into the stomach (G-tubes), through the nose and into the stomach (NG-tubes), or through the nose and into the small intestine (NJ tubes). The NG and NJ tubes are considered to be temporary and the G tube is considered more permanent but it can be removed.

In some circumstances, a person with a feeding tube can continue eating. Here, the feeding tube is providing additional nutrition because of poor intake by the patient. However, the majority of feeding tubes are inserted because the patient has difficulty swallowing and they are unable to continue eating without the risk of swallowing food into the lungs.

The decision to use or not use a feeding tube must be made carefully. Discuss it with your physician, your family, and other persons important to you. It is your right to use or not use a feeding tube. For the persons with severe dementia, a physician must rely on previously stated preferences in an advanced directive or rely on a family member to provide information on the patients wishes. Such decision to use or not use a feeding tube must be based on weighing the risks and benefits?

Benefits:

Does tube feeding prevent aspiration pneumonia?

Aspiration pneumonia is caused by food going into the lungs rather than the stomach. Aspiration pneumonia is common in persons with advance dementia and often indicates that persons are dying. Surprisingly, there is no evidence that tube feedings prevent aspiration pneumonias. Even if tube fed, you are always producing saliva. Tube feeding doesn't correct the swallowing problem with dementia and you are still at risk of aspiration pneumonia. Research has found that persons, despite feeding tubes, a dementia patient still has a high risk of aspiration of pneumonia.


Does tube feeding prolong a person's life?

Data suggests that tube feeding is beneficial if the patient has a reversible illness, which is usually not the case in patients who have advanced dementia. If a person is actively dying, their body no longer absorbs nutrients and cannot utilize the nutrients for the work of the body. Therefore, tube feeding at the end stages of dementia may not be beneficial in prolonging a persons life. Vigorous hand feeding for some persons can prevent the use of a feeding tube. Stopping or not starting a feeding tube in someone who can't be hand fed will result in death. In making a decision regarding the use of feeding tube, ask for a swallowing evaluation by a specialist. There are no easy answers. You should discuss it with your physician, family, and other persons.

Does tube feeding increase quality of life and reduce suffering?

Tube feedings can cause discomfort, the need for physical restraints to prevent the tube from being pulled out, and increased risk infection. Terminally ill patients rarely experience hunger or thirst. Of those who do, relief is achieved with small amounts of food and fluids or by ice chips and lip lubrication.

In addition, tube-fed patients with advanced dementia may miss the human contact that comes with assisted oral feeding.

Are There Alternatives to Tube Feeding?

Getting an appropriate evaluation is key.

Discontinuing medications may reduce eating difficulties. Some drugs, such as sedatives, tranquilizers and anti-cholinergics, may cause difficulty swallowing.

Interventions such as medication adjustments, use assistive devices, changing the type of food, proper feeding technique, and dental care may prevent the use of a feeding tube. Useful techniques include the use of finger foods and preferred foods, strong flavors, hot or cold rather than tepid food, gravy or juices and enrichers such as cream. Other helpful techniques are reminders to swallow and swallow multiple times per bolus, gentle coughs after each swallow, bolus size of less than 1 teaspoon, liquid supplements and facilitation techniques such as vibration, gentle brushing and icing of the cheeks and neck may help. Get an feeding specialist, usually a speech therapist, is important first step.

Where do I turn for help?

Support can come from your family and professionals who can offer guidance and assist with this kind of decision making, such as your physician, nurse, social worker, speech therapist, chaplain, or dietitian. Support from clergy often helps guide a family through this decision. In addition, some hospitals and nursing homes have ethics committees who can assist with decision making on alternative feeding.

The best advice is for persons to state preferences for the use of a feeding tube in an written advance directive.

Links for additional information:

Growth House Handbook for Mortals: Tube Feeding

Alzheimer's Association: Tube Feeding

Choices and Conversations. A Consumer Guide to End-of-Life Care