Proceedings of the Nutrition Society

Postgraduate Symposium

Tube feeding patients with advanced dementia: an ethical dilemma

Edel P. McNamaraa1 c1 and Nicholas P. Kennedya1

a1 Department of Clinical Medicine, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Republic of Ireland

Abstract

Many patients with dementia lose the ability to feed themselves in the advanced stages of the disease. Tube feeding is sometimes initiated to overcome feeding difficulties. Recent studies have questioned the appropriateness of tube feeding in these patients. There is limited research to support the benefits of enteral nutrition in patients with advanced dementia. Deciding whether to tube feed or to withhold tube feeding from a patient with dementia poses a difficult challenge, and many carers may make decisions without adequate information and with an overly hopeful view of the future clinical course. Numerous studies have examined opinions about life-sustaining treatments; many individuals do not want to be tube fed if they were to develop dementia. Results from studies examining the opinions of physicians and other health professionals regarding the use of tube feeding in these patients are conflicting. A number of factors, such as race and cultural background may affect decisions. Healthcare professionals, relatives and patients must be aware of the realistic expectations of tube feeding in patients with dementia, as it can be difficult to withdraw once it has been initiated.

Correspondence:

c1 *Corresponding Author: Edel McNamara, fax +353 1 4542043, email mcnmarae@tcd.ie