Feeding Tubes and Supporting Oral Intake for those with Dementia
Dementia involves a gradual and persistent decline in cognitive function that primarily affects older adults, stemming from various underlying causes. An estimated 6.9 million are living with Alzheimer's dementia today (2024 Alzheimer's Disease Facts and Figures, 2024). There are numerous forms of dementia, each with its own presentation. Alzheimer's disease is the predominant type of dementia which leads to subtle changes with progression to severe cognitive impairment over several years (Wilbur, 2023).
The Alzheimer’s Association (2015) reports that people with advanced Alzheimer's and other dementias often develop issues eating and drinking orally. They further state that neurologic control over swallowing is gradually lost, which can result to diminished abilities to obtain nutrition and hydration, and the potential for aspiration-related pneumonia. Dysphagia presentation can vary based on the type of dementia.
As dementia progresses, and issues with oral intake increase, individuals with dementia and their caregivers may begin to consider the use of alternative sources of nutrition and hydration. It is important that individuals living with dementia and their caregivers are provided with all of the information to make an informed decision, including current research and guidelines, when considering the use of a feeding tube.
The American Geriatrics Society (2014) does not recommend feeding tubes for older adults with advanced dementia, instead, they recommend careful hand feeding as this strategy has been shown to be beneficial in terms of morbidity, aspiration-related pneumonia, comfort, and functional status when compared to tube feedings.
Feeding tubes are associated with agitation, the use of restraints, pressure ulcers, and tube-related complications (American Geriatrics Society, 2014). The Alzheimer’s Association states that research evidence does not support the use of feeding tubes in advance dementia and that feeding tubes may increase harm for those in advanced stages of Alzheimer’s.
To increase oral feeding, strategies and techniques using person-centered approaches such as careful hand feeding as well as education and support for professional and family caregivers regarding feeding approaches are recommended (Alzheimer’s Association, 2015; American Geriatrics Society, 2014). Additionally, environmental manipulations including contrast enhancement such as high-contrast red tableware (Dunne et al., 2004
It is recommended that those dementia as well as their caregivers be provided with education pertaining to the current risks and benefits of tube feeding to make an informed decision (Alzheimer’s Association, 2015; Lynch, 2016). Learn more by exploring the references cited in this post.
