August 21, 2014
Allan S. Brett, MD reviewing American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee. J Am Geriatr Soc 2014 Aug.
Tube feeding is a medical therapy that requires balancing benefits and burdens.Position Statement on Feeding Tubes for Patients with Advanced Dementia.
Sponsoring Organization: American Geriatrics Society (AGS)
Target Audience: Clinicians who care for patients with advanced dementia
BackgroundDeclining oral intake — resulting from both difficulty in eating and loss of desire to eat — is an inevitable part of the natural progression of advanced dementia; it often is addressed by inserting a feeding tube (usually, a percutaneous endoscopic gastrostomy [PEG] tube). A new position statement from the AGS addresses this issue.
Key PointsThe AGS does not recommend tube feeding for older adults with advanced dementia. Caregivers should create individualized hand-feeding approaches, and should recognize that tube feeding usually does not improve survival, comfort, or function in these patients.
Surrogate decision-makers should understand that tube feeding is a medical therapy that requires balancing benefits and burdens. Decisions to insert feeding tubes should be consistent with patients' advance directives and previously stated (or presumed) preferences.
Clinical institutions (e.g., hospitals and nursing homes) should ensure that surrogates are fully informed before making decisions to place feeding tubes; institutions should not pressure families or clinicians to institute tube feeding for convenience or to meet nutritional “quality measures.”
COMMENTMany PEG tubes are placed when patients with dementia are hospitalized with acute illnesses; physicians and families with no prior relationships often make rushed decisions in this setting. But even in outpatient settings, in-depth deliberation about the limitations of tube feedings often is lacking. This succinct and well-written position statement can serve as a guide for clinicians who are committed to involving surrogates in fully informed decision-making regarding tube feeding.
CITATION(S):
American Geriatrics Society Ethics Committee and Clinical Practice and Models of Care Committee.
American Geriatrics Society feeding tubes in advanced dementia position statement. J Am Geriatr Soc 2014 Aug; 62:1590. (Δεν είναι ορατοί οι σύνδεσμοι (links).
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