The Role of Tube Feeding in the Elderly with Advanced Dementia

Dementia is a progressive neurological disease. In the era of aging population, an increasing number of elderly with dementia are now surviving to the advanced stages of their illness. Patients with advanced dementia have a high mortality rate; also, eating and swallowing problems are likely to develop in the terminal stage of dementia. In this regard, tube feeding is often applied. However, the benefits of tube feeding have been harshly challenged during the past two decades. The best evidence to date demonstrates that tube feeding does not confer benefits in terms of nutritional status, development of pressure ulcers or aspiration pneumonia, survival, functional status, or patient comfort as compared to hand feeding. Moreover, patients on tube feeding more likely require physical or chemical restraints, and seek medical help for tube-related complications. Therefore, the widespread use of tube feeding in the elderly with advanced dementia in Taiwan should be seriously reconsidered. Current concepts suggest that hand feeding should be offered for the elderly with advanced dementia. Every effort needs to be made to enhance oral feeding and patient-centered approaches to feeding should be part of usual care for these patients. Certainly, patients or their surrogates have the right to accept or refuse tube feeding after taking into account personal wishes, advance directives and the best welfare of patients. Healthcare providers have the responsibility to promote choice, support shared and informed decision-making, and honor the preferences about tube feeding.