Family members grappling with the decision to allow a feeding tube for a relative with advanced dementia will find little comfort from a new review of evidence.
Poor food intake is common in individuals with dementia for a variety of reasons. In advanced dementia, health care providers might intervene by feeding patients artificially, usually by inserting a feeding tube through the stomach. This decision is emotional, controversial and influenced by complex ethical issues.
But do feeding tubes actually help people with degenerative dementia? In a new Cochrane review from London, doctors searched for evidence that this intervention was beneficial.
"We found that there is no research evidence that tube feeding prolongs survival or improves the quality of life for people with advanced dementia," said lead author Elizabeth Sampson, M.D. "In fact, some studies suggest that tube feeding may have an effect opposite to the desired and actually increase mortality, morbidity and reduce quality of life."
The review appears in the current issue of The Cochrane Library , a publication of The Cochrane Collaboration, an international organization that evaluates research in all aspects of health care. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing trials on a topic.
At first glance, it appears counterintuitive that individuals fail to benefit from tube feeding, but the way that the body utilizes food is complex, Sampson said. With some forms of dementia, the body might be unable to metabolize food properly.
Especially worrisome for families is the pain typically associated with prolonged hunger and thirst.
"In a study with patients terminally ill with advanced cancer and unable to eat, however, few experienced painful feelings of hunger and thirst," Sampson said. "If they did, this pain was alleviated by simple measures, such as pain relief or small sips of water. Compassionate nursing and medical care - similar to that which underlies the philosophy of the hospice movement - can alleviate a great deal of suffering and should be available to people with dementia, too."
Sampson and colleagues are at the Marie Curie Palliative Care Research Unit, Royal Free and University College Medical School.
This research encompassed a review of 452 studies in seven health care databases, five from the United States. Overall, the studies included 1821 people, 409 of whom received some form of tube feeding and 1467 who did not. The researchers found no randomized controlled studies, considered the gold standard of studies.
"Just because we found insufficient evidence of benefit does not mean that for some individuals with advanced dementia, tube feeding is the wrong decision," Sampson said. "Each case needs to be considered individually. We would hope that family members will feel better informed about the pros and cons of tube feeding in persons with advanced dementia because of this paper."
Artificially feeding individuals with dementia is a relatively new phenomenon that evolved after development of the percutaneous endoscopic gastrostomy tube, or feeding PEG, in the early 1980s, said Stephen Post, Ph.D., a professor of preventive medicine at Stony Brook University. Their intent was to nourish seriously ill children until they got well, but by 1985, PEGs became widely used as a cost-saving measure in nursing homes, which lacked sufficient staff to do assisted oral feedings.