One-third of U.S. nursing home patients in the final stages of Alzheimer's and other forms of dementia are given feeding tubes, despite evidence that the practice serves no benefit and may even cause harm, a study found.
People with advanced dementia are generally incapacitated, have trouble swallowing and are near death. Recent studies have shown that feeding tubes do not prolong their lives and may sometimes cause discomfort and infections.
Many geriatric specialists recommend comfort care for such patients, including attempts at spoon-feeding, unless they indicated while still competent that they would prefer aggressive attempts to keep them alive.
The study, which involved 1999 data from al1 15,135 licensed U.S. nursing homes at the time, suggests that some of these patients are given feeding tubes because the practice is seen as less costly and time-consuming than spoon-feeding, said Dr. Susan Mitchell, an assistant professor at Harvard Medical School who led the study.
In addition, many patients do not have advanced directives or living wills, leaving medical decisions up to relatives who may not understand the severity of the dementia and may assume that feeding tubes are warranted, Mitchell said.
Whether to use feeding tubes "is a very complicated decision that really necessitates health-care providers sitting down with families going over pros and cons," Mitchell said.
The study appears in Wednesday's Journal of the American Medical Association.
It found that 63,101 out of 186,835 patients with advanced dementia - 34 percent - had feeding tubes.
For-profit nursing homes were more likely to have patients on feeding tubes, supporting the idea that some institutions believe the practice saves money.
The Alzheimer's Association's guidelines on patients in the final stages of the disease say that it is ethically permissible to withhold feeding tubes and that spoon-feeding should be continued if needed for comfort.
Sandra Fitzler of the American Health Care Association, which represents over 12,000 nursing homes and other institutions, disputed the suggestion that some places may be inappropriately using feeding tubes for patients with advanced dementia.
Fitzler said the study underscores the importance of living wills and advanced directives, so that health care providers and families are not left guessing about patients' preferences.
By Lindsey Tanner
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