A feeding tube can be inserted through the nose into the stomach (NG-tubes), or through the abdominal wall into the stomach. NG tubes can usually only be used for a short time to prevent ulcerations in the nasal tract. If a feeding tube will be used for weeks or months, it is likely that a PEG tube (percutaneous endoscopic gastrostomy) will need to be inserted surgically through the abdominal wall into the stomach.
Sometimes a person with a feeding tube can keep eating. Here, the feeding tube is providing additional nutrition because of poor intake by the resident. Most feeding tubes are inserted because the resident has trouble swallowing and can’t eat without the risk of aspirating food into the lungs.
Risks of Aspiration
Aspiration pneumonia is caused by food or fluid entering the lungs instead of the stomach. It is common in people with advanced dementia. There is no evidence that tube feedings prevent aspiration pneumonia because even if tube fed, people always produce saliva which they may aspirate. Tube feeding doesn’t correct the swallowing problem and residents are still at risk of aspiration pneumonia.
Quality of Life
Tube feedings should be considered very carefully. They can cause discomfort, may require physical restraints, and increase the risk of infection. When considering tube feedings, it is good to remember that terminally ill residents rarely experience hunger or thirst. Of those who do, small amount of food and fluids, mouth care or ice chips can give relief. An actively dying person can no longer absorb nutrients, so tube feeding in the final stages of many progressive diseases may not help to prolong life.
Of course it is the resident’s right to accept or refuse a feeding tube. From an ethical standpoint, removing the tube is the same as not starting tube feedings. But for the person discontinuing the tube, it may feel like a much more active role in the resident’s eventual death.
In making a decision regarding the use of feeding tube, it may be helpful to get a swallowing evaluation by a specialist. Discontinuing medications may reduce eating difficulties. Some drugs, such as sedatives, tranquilizers and anti-cholinergics, can cause difficulty swallowing.
Interventions such as adjusting medications, using assistive devices, changing the type of foods, proper feeding techniques, and dental care may prevent having to use a feeding tube.
In an ideal world, people would consider their choices when not in a crisis, and state their preferences about feeding tubes in advance directives.