|Feeding Tubes - Myths & Realities|
|Saturday, 17 May 2014 00:00|
Feeding tubes were designed to artificially provide nutrition in the hopes of maintaining body weight and health, and to prevent dehydration and starvation, when a person could not eat enough calories for whatever reason.
There are two kinds of feeding tubes. One is inserted through the nose and down to the stomach and taped in place. It is temporary, for up to six weeks, and is usually for people who cannot eat because they are on a breathing machine while in Intensive Care or have had some other procedure preventing them from swallowing. It requires no anesthetic.
The other kind is “permanent” in the sense that (under an anesthetic in an operating room), it is inserted through an incision in the skin of the abdomen and has a bulb or enlargement on the part that’s inside the stomach, which prevents it from being pulled out. Unless the tube becomes corroded or closes off (rare), it never has to be changed.
Many people, including doctors and nurses, mistakenly believe that a feeding tube helps a senior who can’t swallow to live a better and longer life and is necessary to prevent suffering. There are many misunderstandings regarding artificial feeding and the following information will hopefully help seniors and their families make more informed choices regarding the type of care they desire.
Myths: The following are commonly heard statements regarding artificial feeding.
1. Tube feeding prevents aspiration pneumonia
2. It prevents malnutrition
3. It improves survival
4. It reduces pressure sores and the risk of infection
5. It improves functional status or allows patients to be more independent.
6. It improves patient comfort
Reality: What a feeding tube actually does.
1. It actually increases the risk of aspiration pneumonia [pneumonia caused by food going into the lungs—“went down the wrong way”]. Studies show that about six out of ten people (60%) who have a feeding tube develop this pneumonia, compared to about 15% who do not have a tube. In other words, the risk of developing aspiration pneumonia is four times greater with a tube than without one!!
2. It does not prevent malnutrition. In a study of 40 nursing home patients who received tube feedings with adequate calories and protein, they still showed weight loss and severe depletion of lean and fat body mass.
3. It does not improve survival, but probably contributes to a higher mortality.
4. It does not prevent nor reduce pressure sores. In fact, there is no significant correlation between nutrition (as measured by weight, blood protein, etc.) and pressure sores.
5. It does not reduce the rate of infection. The opposite is often the case because feeding tubes can cause sinusitis, ear infections, diarrhea, and skin abscesses.
6. It does not improve functional status (being able to be more independent). One study revealed that after 18 months of such feedings in nursing home patients, none had improvement in functional status.
7. It does not improve comfort. In a study of terminally ill patients with no appetite, few experienced hunger/thirst. In patients with ALS (Lou Gehrig’s Disease) who were tube-fed, aspiration pneumonia increased, and hunger & nausea worsened.
Conclusion: Research confirms feeding tubes provide little benefit for seniors, particularly those with dementia or approaching the end-of-life. National Guidelines in 2014 [Choosing Wisely] specifically recommend against feeding tubes in dementia patients.
Are there any situations when someone might benefit? There are two possible circumstances: (1) someone has untreatable cancer of the esophagus (the channel from the mouth to the stomach) and one of the “permanent tubes” (inserted below the esophagus) would give him a few extra months of life to “do what needs to be done before dying”; or, (2) a person has had a stroke, can’t swallow but is showing early signs of recovery and might benefit from a six week trial of the nasal tube feedings to see if the swallowing mechanism returns.
If a tube is used, what kind of food is given? There are several brands of liquid nutrition (such as Ensure, Glucerna, Jevity) which can be pumped into the stomach either using gravity or a machine. They can be given on a continuous or intermittent basis.
Can people still eat if they have one? Yes, assuming they have no problems with choking. Sometimes a person can swallow pills and can eat a small amount of some foods despite having the tube in place.
Are there any complications from feeding tubes? The nasal type can cause sinus or ear infections, skin infections around the tube, ulcers in the nose or back of the throat and is quite irritating overall. The type placed through the skin in the abdomen can cause skin infections, abscesses, diarrhea, stomach ulcers, and stomach bleeding.
Who should or should not have one? If a patient has the kind of problem which will most likely improve over a few weeks or months, and allow him to return to an acceptable quality of life, then a feeding tube may be appropriate. However, if the feeding tube will only prolong a life without improving a person’s capability to enjoy it, then most choose not to have one placed. In fact, in this instance, many feel it is ethically wrong to insert the tube since in their opinion it is only prolonging the dying process.
Can a feeding tube be removed? Most tubes can be removed fairly easily, with no anesthetic or stitches. People at home or in a nursing home do not have to be transferred to the hospital to have this done. If a nursing home resident has a feeding tube and he or his family believes he has no ability to enjoy life and is not likely to ever have this ability, then it is ethically acceptable to withdraw the artificial support.
If you have any questions about feeding tubes, please ask the nursing staff or your doctor.
1. Finucane TE, et. al. Tube feeding in patient with advanced dementia: a review of the evidence. JAMA 1999;282:1365-70.
2. Dennis MS, et al. Effect of timing and method of enteral tube feeding for dysphagic stroke patients (FOOD). Lancet 2005;365:764-72.
3. Gillick MR. Rethinking the role of tube feeding in patients with advanced dementia. NEJM 2000; 342:206-210
4. Mitchell SL, et al. The risk factors and impact on survival of feeding tube placement in nursing home residents with severe cognitive impairment. Arch Intern Med 1997; 157:327-32.
5. Meier DE, et al. High short-term mortality in hospitalized patients with advanced dementia: lack of benefit of tube feeding. Arch Intern Med. 2001;161:595-9.
6. Mitchell SL, et al. Does artificial enteral nutrition prolong the survival of institutionalized elders with chewing and swallowing problems? J of Geron Series 1998; 53:M207-213.
|Last Updated on Saturday, 17 May 2014 02:16|