Objective: Elderly patients with advanced dementia present a challenge with respect to efficient nutrition and hydration because of oropharyngeal dysphagia and lack of cooperation. For many of these increasing number of patients, tubo-enteral feeding (TEF) is an alternative considered for providing food and fluids with the hope of reducing the risk of aspiration. TEF is practiced unevenly in different countries. In Israel it prevails as an accepted procedure for most advanced demented elderly patients.
Design: The study was designed by a multidisciplinary team.
Materials and Methods: We surveyed all the demented patients on TEF in four skilled nursing and six nursing wards. The purpose was to learn about the clinical condition and the opinion of their relatives regarding the prolonged TEF one-year after it was started.
Results: 111 patients were found: 89 on naso-gastric tube (NGT) feeding and 22 on par-enteral gastrostomy (PEG) feeding. All the patients with NGT were demented, while only 10 were demented in the PEG group. The clinical condition of the patients on TEF was satisfactory as reflected by albumin, hemoglobin and BMI. The attitude of the relatives of the demented patients was ambiguous with regard to the TEF. While most mentioned it is an essential procedure for food and fluids delivery and life support – about the same number emphasized it as prolonging a suffering life. However most relatives were reluctant to the idea of stopping TEF and to “who should decide on it” – staff or family.
Conclusion: The option of TEF for advanced demented elderly was recently questioned. This decision is indeed fraught with medical and ethical concerns. However, beyond this decision, our data show that it does provide efficient nutrition and hydration while satisfying the will of the relatives. Any change in the present approach regarding TEF in demented patients should be preceded by debates that include relatives’ opinions.
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