Take that up with Dr. McConnell, and I' wager there are others who would hold as he does.
Use of Feeding Tubes in Advanced Alzheimer's Disease and Dementia Patients-Part I Within the last 4 months the two most prestigious medical research journals, the New England Journal of Medicine and The Journal of the American Medical Association, have published articles questioning the use of tube feeding in people with advanced cases of Alzheimer's disease and dementia. This appears to be a stance favored by many experts in the dementia field. Figures indicate that presently about 36,000 dementia patients have feeding tubes.The research in these articles involved a review of the medical literature and indicated that there was no evidence that feeding tubes helped most patients. Additionally, they found that this procedure could be harmful in a number of cases.
The iatrogenic effects include infection, diarrhea, and bloating. Another common occurrence is that the patient who feels uncomfortable with a feeding tube will pull it out. This may in turn result in the patient being placed under restraint.
The NY Times (Jan. 20, 2000) quotes Dr. Stephen McConnell, a spokesperson for the Alzheimer's Association which was not a participant in these studies: "This is a position we actually took years ago, that it is ethically permissible to withdraw or withhold hydration and nutrition from somebody in advanced stages. Now there's some scientific evidence that tube feeding doesn't do what everybody thinks, prolong life or make people more comfortable."
Dr. McConnell is further quoted as saying that the tube is often used for the convenience of nursing home staff. "The problem in homes is that it is costs more to pay a person to feed a patient that it does to just jam in a tube and walk away." This statement arises because of the amount of time that the nursing home staff member would have to spend trying to plead and cajole such a resident into taking even a slight amount of nutrition. When you have several such residents in one wing of the home the staff members could be tied up for many hours per day trying to feed the residents.
Then there is the question of insurance payment. Insurers pay for a feeding tube, but do not pay to have a staff member feed a resident. The former is a reimbursable medical procedure and the latter is an activity of daily living, not separately reimbursable because it involves a functional activity.
Dr. Muriel Gillick wrote the article in the New England Journal of Medicine. Dr. Gillick is associate professor of medicine at Harvard and staff doctor at the Hebrew Rehabilitation Center for the Aged in Boston. She compared tube fed patients with non tube fed patients and found that they do not live longer, nor do they show signs of being better nourished than the non tube fed patients. She also reported that the tube fed patients have lung problems from choking on their own saliva and stomach secretions. Dr. Gillick indicated that elderly people with advanced dementia who have eating problems die within six months, whether they have a feeding tube or do not have a feeding tube. It is Dr. Gillick's feeling that loss of appetite in Alzheimer's disease is a sign of the final stage in a fatal disease. Such terminally ill people "not given food or water did not suffer hunger or thirst and could be kept comfortable with ice chips and swabs to moisten the mouth and lips. Dehydration leads them to lapse into comas and die peacefully..." (NY Times, Jan. 20, 2000)
Harold Rubin, MS, ABD, CRC, Guest Lecturer
January 22, 2000
http://www.therubins.com/geninfo/feedtubes.htm <-- Link
Other readers of this post are encouraged to visit that link. Here are later paragraphs.
Our mother died ten days before they were to remove this tube. She had lived along and fulfilling life. We had researched the effects of dehydration and starvation and were comfortable with the researchers who felt it would not be painful.The situation with our mother is different than the terminally ill dementia or cancer case. She was in neither of these cohort groups.
Dr. McConnell is further quoted as saying that the tube is often used for the convenience of nursing home staff. "The problem in homes is that it is costs more to pay a person to feed a patient that it does to just jam in a tube and walk away." This statement arises because of the amount of time that the nursing home staff member would have to spend trying to plead and cajole such a resident into taking even a slight amount of nutrition. When you have several such residents in one wing of the home the staff members could be tied up for many hours per day trying to feed the residents.
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I would like to address the above comment that you posted...I have worked in nursing homes for years and years....and have seen only two geriatric persons with a feeding tube...we had several younger residents, with feeding tubes, but none of the old people...and almost all of the residents were geriatic residents, the younger residents being in the minority...
As to feeding the residents...we did spend lots of time, escorting the residents to the dining room, and feeding them...many of them were unable to feed themselves, and everyone, the nurses and the aides, and the entire staff helped to feed the residents, who could not feed themselves...myself, I found it to be a more relaxing duty to perform....a crucial part of working in a nursing home, is helping the residents with their activities related to daily living...and of course, eating and drinking falls into that category...
I know of all the nursing homes in my area(Olympia, Washington) , and I have yet to see one, where the geriatric residents are given feeding tubes as a general rule, so as to be more convenient for the staff...in fact, that seems to be more inconvenient for the staff...in then nursing homes where I worked, only the nurses can feed residents via feeding tubes...aides cannot do this...if most of the geriatric residents were tube fed, the nurse would be spending all day attending to feeding tubes, rather than passing meds, attending to IVs, performing medical procedures...
I cannot answer for other nursing care facilities...just do know that in my, area, no nursing home has most of its residents on tube feeding...
I would be greatly interested in seeing and hearing about actual nursing homes, which do prefer most of their residents to be tube fed, and the justification for this...
Most of the seniors I have taken care of, do enjoy eating, ,and appreciate the care we take to feed them...
I must say, I have been learning a few things from this thread...thanks...