Risks of Feeding Tubes in Dementia

Dementia often leads to a need for feeding assistance but feeding tubes are a controversial option

(RxWiki News) People with dementia often need help eating and are at higher risk of getting pressure sores. Feeding tubes are often used to ensure that patients are getting all the nutrients they need, but do feeding tubes help?

Past research is divided. Proper nutrition is needed to recover from a pressure sore, but a feeding tube may actually increase risk factors for getting or not healing from a pressure sore. Newer research says that feeding tubes are not the best option.

"Talk to a dietician about ways to improve nutrition"

There are two options when a person with dementia needs feeding assistance: feeding tube or hand feeding. The tube ensures that the patient receives the nutrition they need, but patients often have to be restrained to keep them from taking the tube out. 

Hand feeding requires extra hospital staff and can result in difficulties getting the patient to take in the needed nutrients.

A recent study, led by Joan Teno, MD, of the Warren Alpert Medical School of Brown University, looked at 1,124 nursing home patients with advanced cognitive impairment who had a feeding tube inserted to see what the likelihood of developing a pressure sore was.

They found that the feeding tube increased the odds of getting a pressure sore more than two times compared to people whose nutritional needs were met without a feeding tube.

Dr. Teno's team also looked at 461 nursing home patients with dementia who were hospitalized for treatment of a pressure sore to see if getting a feeding tube helped them to recover. They found that having a tube inserted lowered the odds of the pressure sore healing.

The authors conclude that the increased odds of pressure sores with a feeding tube could be due to restraints that are often needed and because a feeding tube puts a patient at risk of diarrhea. Both lack of mobility and diarrhea are risk factors for pressure sores. 

Dr. Teno and colleagues recommend that feeding tubes should be avoided in people with advanced dementia whenever possible.

Colleen Christmas, MD, and Thomas Finucane, MD, published a commentary about Dr. Teno’s research. They noted that previous efforts to look at this problem have had problems with finding a way to really see risks and benefits. They commended Dr. Teno’s use of a new method of researching the problem.

“In our opinion, physiology and morality each support an approach in all settings where all patients with severe dementia should be offered a conscientious, careful program of hand feeding. We should ask for evidence of benefit before force feeding beyond what the patient desires.”

The study and commentary were published in May in the Archives of Internal Medicine. The authors report no conflicting financial affiliations.

Review Date: 
May 15, 2012