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 Researchers focused on the sickest dementia patients who tend to
have difficulty chewing and swallowing as they near the end of life,
a point when they may also struggle to speak, recognize loved ones,
get out of bed or go to the bathroom independently.
The proportion of these advanced dementia patients who got feeding
tubes when they couldn’t eat on their own dropped from 12 percent in
2000 to 6 percent in 2014, according to an analysis of data on
71,000 nursing home residents published in JAMA.
“Families should understand that by foregoing tube-feeding, care is
not stopped,” said lead study author Dr. Susan Mitchell of the
Hebrew SeniorLife Institute for Aging Research at Harvard University
in Boston.
“Rather, care is focused on treatments that maximize comfort and
quality of life,” Mitchell added by email.
No rigorous studies over the past two decades have shown feeding
tubes can benefit advanced dementia patients, Mitchell noted.
When families understand this, they increasingly opt instead for
palliative care with an emphasis on comfort and quality of life.
There was, however, a stark racial divide in feeding tube use.
The proportion of white dementia patients who got feeding tubes
dropped from 8.6 percent to 3.1 percent during the study period,
while the decrease for their black peers was from 38 percent to 18
percent.
One limitation of the study is that it focused on a subset of
nursing home residents with advanced dementia that had been
identified as needing help to eat, which may underestimate the
number of feeding tubes inserted, the authors note.
Another shortcoming is that the proportion of U.S. nursing home
residents with advanced dementia and eating problems declined during
the study period as more such individuals received care in other
settings. This, too, might mean the findings don’t reflect every
advanced dementia patient that received a feeding tube.
Instead of focusing on feeding tubes, families can find out what
types of nutrition may be easier for advanced dementia patients to
consume, said Dr. Laura Hanson, a geriatric medicine researcher at
the University of North Carolina in Chapel Hill.
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“If the person has advanced dementia such that they require help
with all basic activities and struggle to recognize family, families
should understand that a feeding tube simply won’t help,” Hanson,
who wasn’t involved in the study, said by email. “But they may wish
to talk with an expert about types of food and drink, and techniques
to help with eating by mouth.”
A separate study of about 400 hospital patients who received feeding
tubes in Israel found worse outcomes when people had dementia than
with other neurological problems or medical issues such as cancer.
Compared with other people in the study, the dementia patients who
received feeding tubes had higher rates of repeat hospitalizations
six months later and shorter survival times.
Researchers also did lab tests to see how much feeding tubes
actually helped provide nutrition and found less evidence that it
did with dementia patients than the other participants.
The findings in Israel, published in the Journal of Clinical
Gastroenterology, mirror other research that’s been driving a
decline in feeding tube use for advanced dementia patients in the
U.S., Hanson said.
“Several studies compare persons with advanced dementia who do or do
not receive a feeding tube, and show this procedure does not add to
survival time, function or offer other health benefits,” Hanson
said.
SOURCE: http://bit.ly/1c9i5E4 JAMA, online August 16, 2016 and
http://bit.ly/2bkrPB2 Journal of Clinical Gastroenterology, online
August 8, 2016.
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