New Study Finds Overuse of Feeding Tubes in Advanced Dementia Patients
A new study in the Journal of the American Medical Association (JAMA) finds that the decision to give patients with advanced dementia feeding tubes depends more on cost concerns than the patient’s well-being. Hundreds of patients surveyed by Dr. Joan Teno of Brown University were given a feeding tube although they had specified in writing that they did not want one.
Feeding tubes do not increase survival for people with dementia who can no longer swallow. Rather, they can cause harm as demented patients often try to remove them, and are then consequently physically restrained or placed on heavy sedatives. Dementia is receiving more recognition as a terminal illness. Trouble eating indicates the arrival of the final stage of the illness, and careful hand feeding can provide the patient with a safer and more comfortable alternative than a feeding tube. However, feeding by hand requires a lot of time and effort.
Cost concerns are likely a significant factor in the large use of feeding tubes. Inserting a feeding tube allows hospitals to discharge patients faster and is less time-consuming for nursing homes. It is difficult to tell if hospitalizing demented patients is helpful, and ultimately financial incentive may be driving this tendency to feeding tube insertion. About a third of nursing home patients with advanced dementia have feeding tubes, and tubes were inserted into two-thirds of these patients while they were in the hospital. For-profit hospitals and larger hospitals are also more likely to use feeding tubes.